Pride Month: When 27-year-old Ayaan (name changed), a trans man from Delhi, underwent top surgery last year, he described it as “the beginning of truly seeing myself in the mirror.” For him, it marked the culmination of nearly a decade of emotional and social struggle. More than a medical intervention, it represented affirmation, identity, and dignity.
In Delhi, gender affirmation surgery (GAS)—also referred to as gender reassignment or sex reassignment surgery—is becoming increasingly accessible through both government and private hospitals. This set of procedures, which helps transgender individuals align their bodies with their gender identity, has brought relief to many. But access remains uneven, and those seeking it often face bureaucratic hurdles, societal prejudice, and inadequate support systems.
A growing demand, a difficult journey
In recent years, prominent government hospitals in Delhi—including Lok Nayak Hospital, Dr Ram Manohar Lohia Hospital, All India Institute of Medical Science (AIIMS), Safdarjung Hospital, and Sir Ganga Ram Hospital—have begun offering gender affirmation procedures. These include top surgery (mastectomy), bottom surgery (vaginoplasty or phalloplasty), and facial feminisation procedures.
Dr Swaroop Singh Gambhir, Senior Consultant Plastic Surgeon at Sir Ganga Ram Hospital, attributes this shift to both legal and societal changes. “After the NALSA verdict in 2014 and the enactment of the Transgender Persons (Protection of Rights) Act in 2019, the government has been obligated to provide gender-affirming healthcare. We’ve seen a steady rise in inquiries, and patients are more informed now.”
According to Dr Gambhir, a full medical transition—spanning counselling, hormone therapy, and surgery—typically takes two to three years. Each patient’s journey is unique, and a multidisciplinary team of psychiatrists, endocrinologists, and surgeons is essential to ensure that individuals are mentally and physically prepared at every step.
Despite growing demand, infrastructure remains inadequate. “We need more dedicated wards, more trained staff, and more awareness within our own systems,” he says.
Long waits, endless paperwork
Although procedures have become more widely available, access to surgery is still riddled with procedural delays and documentation hurdles.
Riya, a 24-year-old trans woman from Faridabad, recently applied for surgery at a Centre government-run hospital. “Getting the paperwork in order is harder than getting the surgery date,” she says. “They ask for your transgender certificate, then your Aadhar to match your new name and gender, and it takes months. Sometimes, you feel like giving up.”
Applicants are required to provide affidavits, psychological evaluations, and a certificate of gender dysphoria. Dr Gambhir acknowledges the burden: “We’re trying to streamline the documentation. But we also need better digital integration between hospitals and UIDAI databases.”
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“We’re fighting to be seen”
For many in the transgender community, the struggle goes far beyond medical access.
“Most of us aren’t just fighting for surgery—we’re fighting to be seen,” says Mehak, a 32-year-old trans woman and community worker in East Delhi. She has been on hormone therapy for three years and is currently waiting for surgery at a Delhi government hospital. The process, she says, is long and exhausting, especially due to the red tape. “But this is still a big shift—we never had these services in government hospitals before.”
Kai R, a 28-year-old awaiting approval for surgery, recounts the psychological toll. They describe going through months of psychiatric evaluations and facing invasive questions about their childhood. “What hurts most isn’t just the waiting—it’s the constant message that my truth needs external validation,” they say. Every appointment, they add, feels like a test where they’re “graded on how convincingly I can perform my own pain.” Kai says the system treats transition as a privilege rather than urgently needed healthcare. “How many times must I say ‘This is me’ before they finally listen?”
For many, particularly those from low-income backgrounds, government hospitals are the only feasible option. Private hospitals offer quicker procedures but come at a steep cost.
“It’s not a cosmetic procedure. It’s life-saving for many of us. For some, it’s the difference between living and merely surviving,” says Mehak.
Private hospitals: Speedy care at a cost
Private healthcare institutions like Fortis Hospital have been offering gender affirmation surgeries for over a decade, but affordability remains a barrier.
Dr Richie Gupta, Senior Director and Head of Department (Plastic and Reconstructive Surgery) at Fortis Hospital, Shalimar Bagh, says, “We offer comprehensive gender affirmation procedures using international protocols based on WPATH guidelines.”
He outlines the cost: “For a complete male-to-female transition, which typically involves two major procedures, the estimated cost ranges between Rs 5 to Rs 7 lakh. In contrast, a female-to-male transition, requiring four to five surgeries, may cost approximately Rs 10 to Rs 15 lakh. These expenses are distributed across the different stages of the transition process.”
According to Dr Gupta, there is no waiting period once psychiatric clearance and other prerequisites are met.
Mental health: A missing piece
Many transgender individuals report that hospitals offer psychiatric evaluations prior to surgery but lack post-operative mental health support.
“We’re often left to fend for ourselves after the surgery,” says Ayaan. “You go through such a massive change, but there is no one to talk to about your feelings, your fears, or even the complications.”
The absence of sustained psychological counselling often leads to post-surgical depression or identity confusion.
Dr Trideep Choudhury, Consultant Psychiatrist in the Department of Mental Health and Behavioural Sciences, says psychological assessments serve a protective function. “These evaluations are not meant to invalidate a person’s gender identity, but rather to confirm the presence of persistent gender dysphoria while screening for any coexisting mental health conditions that could impact decision-making or post-transition adjustment.”
He explains that the six-month diagnostic requirement and comprehensive evaluation help distinguish between transient distress and deeply ingrained gender incongruence. The assessments explore the stability of gender identity, the patient’s understanding of surgical risks and outcomes, their support systems, and their ability to provide informed consent.
Dr Choudhury adds, “Mental health professionals also play a vital role in preparing patients for the social and emotional aspects of transition. We help them develop coping strategies for workplace discrimination, family rejection, and adjusting to physical changes. The requirement for documented hormone therapy and living in a gender-congruent role before surgery serves as a real-life test of commitment.”
Post-operatively, psychiatrists provide continued support. “Our goal is never to create unnecessary barriers, but to ensure that individuals are optimally prepared for success in all aspects of their lives. These safeguards protect vulnerable populations and uphold the highest standards of ethical medical practice,” he says.
Models of inclusion: Rajasthan leads
While Delhi remains a hub for gender-affirming care, Rajasthan has taken a significant step forward by covering the costs of surgeries under the Chiranjeevi Health Insurance Scheme.
Delhi-based activists believe the Capital should follow suit. “It’s time Delhi developed its own support scheme for trans healthcare. We can’t keep asking people to crowdsource their dignity,” says Vikas, a queer activist.
He also emphasises the importance of holistic care, including mental health counselling, documentation support, and post-operative follow-ups. “Surgery is just one step. The journey is long, and most people don’t have the support they need.”
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Training the next generation
Dr Gambhir notes that building a more inclusive healthcare system also means preparing future doctors.
“We’re introducing modules in medical colleges about gender identity and inclusive care,” he says. “But true change will take time. Many professionals still use outdated language and attitudes.”
He also stresses the need for more training in surgical techniques specific to gender affirmation. “It’s a highly specialised field. Not every plastic surgeon is equipped to do this. We need more fellowships, workshops, and clinical exposure.”
The road ahead
Despite ongoing hurdles, members of the transgender community in Delhi remain cautiously optimistic. The increasing number of surgeries, growing awareness, and policy-level discussions signal slow but tangible progress.
For Mehak, the change is personal and hard-won. “I’ve waited years to be who I am. The world is slowly catching up. I just hope it does so before another generation of us has to suffer in silence.”
