Is India ready for queer-affirmative mental health?

India’s queer community is struggling with mental health amid stigma, pushing for reforms to ensure affirming care

The queer community in India continues to navigate a complex web of social, cultural, and legal obstacles. The intersection of mental health and gender identity remains a neglected and under-explored concern. While India has made strides in recognising the rights of its transgender citizens—through landmark decisions like the NALSA (National Legal Services Authority) Judgment in 2014, which recognised transgender persons’ right to self-determination of their identity—the reality for queer individuals seeking mental health support remains fraught with societal stigma, systemic discrimination, and a lack of understanding from the very professionals meant to aid in their healing.

These barriers are starkly evident when we look at the continued resistance to gender-affirming care within both medical and spiritual circles in India. Just as the medical community is yet to fully acknowledge the importance of gender-affirmative care, certain influential spiritual leaders promote transphobic views that harm young people grappling with their gender identity. These systemic failures not only prevent individuals from receiving the support they need but further exacerbate their struggles, contributing to the alarming rates of mental health issues within the queer community, particularly among trans and gender-diverse individuals.

An Aggressive Pushback Against Gender-Affirmative Care

In December 2021, at a conference held by the Indian Academy of Paediatrics (IAP) and the Growth Development and Behavioural Paediatrics (GDBP) in Agra, a series of alarming and transphobic statements were made by paediatricians, They actively warned parents against gender-affirming practices for children, dismissing them as a passing "trend" thanks to influences via Western nations.

The doctors at the conference posited that children as young as three years of age begin to "think about sex" and "differentiate themselves from the 'opposite sex.'" However, the doctors maintained that instead of offering supportive, gender-affirming care to these children, parents should “lovingly explain” traditional binary gender norms, effectively endorsing conversion therapy. According to them, gender dysphoria—an experience where one's gender identity does not align with the sex assigned at birth—was primarily seen in those assigned male at birth (AMAB) but was now reportedly increasing among those assigned female at birth (AFAB). They blamed Western influence for the rise in gender dysphoria, presenting it as a trend adopted by economically developed nations, dismissing any local nuance or understanding.

This position is not only devoid of scientific backing but reflects a broader global backlash against gender-affirming practices that provide life-saving care to trans and gender-diverse individuals. “There has been a lack of affirming information about the transgender experience or transitioning out there,” explains Dr. Dheeraj Kapoor (he/him), a Mumbai-based  endocrinologist with experience consulting with transgender individuals since 2009. “There’s a critical gap in understanding within the medical community when it comes to transgender care. For many years, patients seeking gender-affirming treatment were seen through a psychiatric lens, often misunderstood and dismissed. This culture of stigma needs to change for trans people to receive the healthcare they deserve.” 

In stark contrast to the IAP's stance, the American Academy of Paediatrics (AAP) held its ground in August 2021 by shutting down any debate on the legitimacy of gender dysphoria, maintaining its stance on gender-affirming care as essential for the mental and physical well-being of trans youth. Research presented at the AAP’s National Conference & Exhibition in October 2021, confirmed that puberty blockers, which delay the onset of puberty, can significantly reduce suicidal ideation and depression in transgender adolescents, underscoring the importance of providing such care as early as possible. Kapoor further notes, “When beginning HRT (hormone replacement therapy) or gaining access to surgical procedures, many of them feel like they can now be who they always wanted to be in the world. I have observed that this helps many of them get off anti-depressants and begin to feel elated about their experience in their body.”

The rhetoric from the conference in Agra, however, disregards these findings, instead choosing to advocate for a harmful practice of imposing gender norms on children who may not identify with them. It is also crucial to note that at the same time as this transphobic rhetoric was being circulated in medical circles in the country, the Kerala High Court issued a directive urging the state government to create specific guidelines to combat conversion therapy practices. The rise in these practices, particularly during the COVID-19 lockdowns, made homes unsafe spaces for many LGBTQIA+ individuals, young and old alike. The correlation between increasing reports of violence and coercion in the name of “curing” queerness and the growing push against queer-affirmative medical care highlights the broader cultural resistance to queerness in India.

Kapoor also observes that when gender dysphoria—the distress a person feels when their gender identity doesn’t align with the sex they were assigned at birth—goes unaddressed, their mental health often declines. “Depression and suicidal tendency often increase with the experience of such dysphoria,” he explains, “as they also struggle to be accepted by their loved ones and the world at large around them.” 

The Influence of Religious and Spiritual Leaders

In addition to the pushback from the medical community, queer individuals in India also face significant obstacles from spiritual spaces. Shaman Gupta (he/him), a trans rights advocate and co-founder of the Misfyt Trans Youth Foundation—that functions between Mumbai and Delhi—explains that spiritual leaders, or “god-men,” often hold sway over communities, where their opinions shape public perception. Many of these leaders are openly dismissive of gender-diverse people and spread misinformation. According to Shaman, they perpetuate an environment where young people seeking affirmation for their gender identity are met with scepticism or outright rejection.

“They’re not only transphobic but are also outright harmful,” explains Shaman . “They perpetuate harmful ideas that trans youth are somehow confused or being influenced, and this adds to the trauma and confusion many of them feel.” He points to how these figures often spread the idea that gender identity is immutable and tied strictly to biological sex, further marginalising gender-diverse people who don't conform to these rigid norms.

To combat this, Misfyt Trans Youth Foundation is running a petition campaign to put an end to conversion therapy, and is hoping to submit it to various departments of the Government of India to bring about policy changes that will effectively implement and enforce a ban on its practice.

The Struggle for Mental Health Support

For queer individuals in India, these barriers aren’t just limited to accessing medical or spiritual support—they often translate into deep psychological harm. Many face rejection from their families, schools, and communities, leading to depression, anxiety, or suicidal ideation. The sense of isolation felt by many queer people is exacerbated by the lack of mental health professionals who are both qualified and willing to offer affirming care.

Forty-three-year-old O (anonymised upon request), a designer living in Pondicherry, shared their story of abuse and confusion growing up queer. Having been sexually abused by multiple figures during their childhood, they felt immense guilt and self-loathing, unsure how to navigate these complex feelings. “I often wanted help, but I didn’t know where to go,” they explain. This lack of access to appropriate support left them to struggle with their identity and trauma alone, as they sought answers through self-reflection and reading. O’s story underscores a critical issue: the need for specialised, queer-affirmative mental health care. Without it, queer individuals are left to wrestle with both the trauma of societal rejection and personal identity struggles without a proper framework or support system to guide them. As Shaman puts it, the medical community in India needs to move beyond “queer-friendly” language to truly “affirm” queer identities in a way that empowers individuals to live freely. “This means understanding the complexities of queerness—not just accepting it as an identity, but recognising the ways it impacts the entire person,” he says.

Vijay (he/him), a 40-year-old trainee counsellor and peer-support provider based in Bengaluru, emphasises the role of lived experience in supporting queer and trans individuals. "My lived experience as a queer person is indeed knowledge," he explains. Having worked as part of the Safe Access peer support program for two years, he stresses the unique challenges queer and trans individuals face when seeking mental health support, particularly from therapists who may label themselves as "queer-affirmative" but lack a true understanding of the lived realities of the community. "I've heard people share their traumatic experiences with therapists lacking the lived experience of queerness. Even though they may call themselves queer-affirmative, the challenges faced by queer and trans clients in Indian society are not understood by them," shares Vijay.

He goes on to detail how this lack of understanding extends to complex issues like gender dysphoria, body dysphoria, and the diverse subsections within the queer community. "Not many people even understand the experience of an asexual person," he points out. This misunderstanding from well-meaning but ill-informed therapists can result in further harm to clients, leading many to give up on therapy altogether. "Many people have even lost hope in therapy because of the difficult situations they have been forced into due to the actions of these therapists," he notes. Vijay also highlights the barriers of caste and class that queer individuals face when trying to access mental health services, with therapy often being perceived as an elitist space inaccessible to many.

Vijay further underscores the importance of queer and trans-affirmative therapists educating themselves about the diversity within the LGBTQIA+ community. “Just because we identify ourselves as queer doesn't mean we automatically know every experience within the community," he says, stressing that therapists need to understand that queer people’s experiences vary widely depending on factors like gender, sexual identity, and caste. "It's essential that we educate ourselves about the nuances of queer and trans lives and realities," he asserts.

“In the therapeutic space, we must not focus on imposing an idea of a 'perfect' coming out or transition," says Shipra Parswani (she/her), a Mumbai-based psychotherapist who has worked with queer communities for years, "while being curious  about what gender-affirming care looks like for each client.” She further explains, "When therapists ask clients questions out of curiosity about queer or trans identities, it can shift the dynamic, placing the responsibility of educating the therapist on the client. This can feel like an additional burden when they’re already navigating complex emotions and identities."

“For many clients, ‘coming out’ goes hand-in-hand with loss,” points out Meghana Devotta (she/her), a 29-year-old therapist who works out of Bengaluru. When asked if her training has prepared her for the job, she says, “Restructuring one's worldview is a lifelong process and it's obviously not accomplished in four-hour lectures over a two-year programme. Nothing is neat and sequential. Theories give you a sense of comfort in having the knowledge, but that unravels quickly in the face of messy realities.”

Shipra adds, “Queer and trans clients often carry a history of trauma from experiences of rejection or violence. In our sessions, I prioritise recognising how their bodies store these emotions and memories, acknowledging that healing isn’t just about the mental, but also about physical and emotional release.” Shipra also highlights the need for therapists to avoid asking clients overly personal questions out of curiosity, as this can shift focus from the client's emotional work to educating the therapist. "Simple ways such as asking them the name they would like to be called, their pronouns, and offering a space where they can be themselves can make them feel safe in their bodies," she adds, emphasising that this helps clients feel more confident in their identity and experience.

Breaking the Silence: Creating Queer-Affirmative Spaces

Despite these challenges, there has been progress, albeit slow. More and more queer mental health professionals, support groups, and advocacy organisations are emerging to fill the gap created by traditional systems. The Misfyt Trans Youth Foundation, for example, is working not only to offer housing support to trans youth but also to engage in policy advocacy, including the campaign to put an end to conversion therapy in India.

O’s advice echoes the importance of timely intervention: “Don’t delay looking for mental health support,” they urge. “It’s less stigmatised today than it was two or three decades ago.” While this may be true in urban India, for those in rural areas or smaller towns, accessing affirming care remains a distant dream. The struggle, however, is far from over, and the collective work of mental health professionals, activists, and organisations will continue to make a much-need difference.

“As a therapist, you have to sometimes actively advocate for clients, which means building an appetite for conflict and confronting unfairness. How to channel outrage and anger, and how to work with or navigate unhelpful or discriminatory systems are skills I had to learn on the job. Critiquing is an easier skill than finding a way to address it,” reflects Meghana.

The Indian queer community’s fight for mental health and gender-affirming care is an ongoing battle that can no longer be ignored. As Shaman aptly points out, the future of queer mental health in India hinges on systemic change, both within medical and educational institutions and across societal attitudes.

Curated by Gaysi Family | Illustration by: Anjali Nair

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