In recent years, the visibility and advocacy for transgender health issues in India have taken a remarkable leap, reflecting a broader shift in social and medical perspectives across the globe. The comprehensive study “Trans-health in India: An Approach to LGBTI Well-Being” by Chawla and Nilavathy published in the International Review of Economics showcases a nuanced and technical analysis of the systemic challenges and policy frameworks surrounding transgender healthcare in India. This work meticulously reveals the interconnectedness of socio-economic, cultural, and legislative factors crucial to improving health outcomes for transgender populations and the wider LGBTI community.
India presents a unique context in trans-health due to its intricate cultural tapestries and profound traditional gender identities, such as hijras and kothis, which have existed for centuries yet remain marginalized. Chawla and Nilavathy’s research navigates these cultural dynamics, illustrating how historical recognition paradoxically fails to translate into adequate healthcare access, legal protections, or economic inclusion. By employing a multi-disciplinary approach integrating economics, sociology, and public health, the authors spotlight systemic inequities that reinforce health disparities within trans populations.
One of the core technical aspects of the research deals with the structural challenges faced by transgender individuals in accessing gender-affirming medical interventions. India’s healthcare infrastructure, while rapidly expanding, often suffers from a lack of trained professionals aware of or sensitive to transgender health needs. The article discusses the scarcity of endocrinologists and mental health specialists competent in transgender care, compounded by the absence of standardized clinical protocols across different states. This leads to inconsistent and often unsafe medical practices, including self-medication and unregulated hormone treatments, posing significant health risks.
Moreover, Chawla and Nilavathy delve deeply into the economic barriers that exacerbate health inequities in this demographic. Financial exclusion, employment discrimination, and lack of social security nets intersect to create an economic landscape in which many transgender individuals live in poverty or near poverty. The paper quantitatively analyzes how such economic marginalization directly impacts access to quality healthcare, preventive services, and post-treatment support, exacerbating chronic health conditions and mental health issues linked to minority stress.
Legislatively, the landscape in India has undergone pivotal changes in the last decade, notably with the Supreme Court’s landmark 2014 judgment recognizing transgender individuals’ rights. However, this study goes beyond the surface to analyze the enforcement gaps and policy implementation challenges. The authors critically evaluate the Transgender Persons (Protection of Rights) Act 2019, assessing its pitfalls, including bureaucratic hurdles in identity certification and the gap between policy provisions and ground realities, where stigma and discrimination persist unabated.
The evidence provided in the article advocates for the integration of trans-health into national health policies, emphasizing the necessity for comprehensive, inclusive frameworks that address both physical and mental health holistically. Mental health, as highlighted extensively, is a crucial yet underexplored dimension in transgender well-being. Chawla and Nilavathy underscore the high prevalence of psychiatric morbidity, suicidality, and trauma-related disorders within this community, calling for tailored therapeutic interventions embedded in de-stigmatizing and culturally sensitive healthcare environments.
In addressing healthcare delivery innovations, the research discusses emerging telemedicine platforms in India, which hold promise in bridging geographical and social barriers to care. It evaluates pilot programs where telehealth services have been leveraged to provide hormone therapy guidance and psychological counseling, particularly during the COVID-19 pandemic, which further exacerbated access challenges but also catalyzed digital health solutions.
Significantly, the study proposes a comprehensive model for transgender health that includes legal recognition, economic empowerment, social inclusion, and healthcare integration as mutually reinforcing pillars. The authors stress the importance of community-based participatory research methodologies to inform policies that genuinely reflect the lived experiences and health priorities of transgender individuals themselves, thus enhancing the sustainability and impact of interventions.
At the intersection of health and economics, this paper also highlights the cost-effectiveness of investing in trans-health. By prioritizing preventive and gender-affirmative care, the authors argue, India could reduce long-term healthcare expenditures attributable to untreated chronic conditions and mental illnesses, while simultaneously improving productivity and economic participation within the transgender community—a demographic with substantial untapped human potential.
The role of NGOs and grassroots organizations emerges as a critical factor in advancing trans-health in India. Chawla and Nilavathy meticulously document how civil society initiatives have pioneered inclusive healthcare services, legal aid, and advocacy forums. These entities often fill critical gaps left by governmental institutions but require sustained financial and policy support to scale their impact across India’s diverse regions.
Cultural competency training for healthcare workers is another technical recommendation drawn from this research. The authors call for the integration of transgender health modules into medical education curricula to dismantle biases and equip professionals with the necessary skills to provide respectful, affirming, and effective care, aligning with global best practices and standards such as the World Professional Association for Transgender Health (WPATH) guidelines.
Furthermore, the article discusses data collection and research infrastructure deficits. India’s limited epidemiological data on transgender health is a considerable barrier to evidence-based policymaking. The authors propose establishing centralized health registries and incorporating sexual orientation and gender identity variables into national health surveys to capture a comprehensive picture necessary for targeted program development.
The intersectionality framework is a pivotal analytical tool employed in this research, addressing how caste, socioeconomic status, rural-urban divides, and religious affiliations compound transgender health disparities. This layered approach reveals that trans-health solutions cannot be unidimensional but must consider multiple axes of identity and marginalization to be efficacious.
In conclusion, Chawla and Nilavathy’s in-depth study presents a visionary yet pragmatic roadmap for advancing transgender health in India within the broader LGBTI well-being framework. Their rigorous synthesis of socio-economic data, legislative critique, and health system analysis provides stakeholders—including policymakers, healthcare providers, and civil society—with a vital evidence base and actionable recommendations. The imperative is clear: to shift from mere legal acknowledgment toward meaningful, sustainable health and social equity for transgender individuals in India, thereby catalyzing broader LGBTI inclusion and empowerment.
Subject of Research:
Transgender healthcare access, policy, and socio-economic factors impacting LGBTI well-being in India.
Article Title:
Trans-health in India: An Approach to LGBTI Well-Being.
Article References:
Chawla, K., Nilavathy, K. Trans-health in India: An Approach to LGBTI Well-Being. International Review of Economics, 73(4), 2026. https://doi.org/10.1007/s12232-025-00516-8
Image Credits: AI Generated
DOI: https://doi.org/10.1007/s12232-025-00516-8
