How six years of gender clinics in T.N. have improved access to healthcare for transpersons Premium

Gender clinic at RGGGH in Chennai offers free gender affirmation surgeries and hormone therapy for transgender individuals.

John (name changed), a 28-year-old transman, felt a wave of nervousness as he walked into the gender guidance clinic for transgender persons at Chennai’s Rajiv Gandhi Government General Hospital (RGGGH). But that anxiety soon gave way to relief. At the clinic, he underwent a series of counselling sessions and medical consultations with a team of doctors before proceeding with gender affirmation surgery.

“The doctors at RGGGH were very friendly. They made me feel comfortable throughout the surgery and recovery,” says Mr. John, who got a mastectomy. “I can’t even feel the stitches now. More importantly, I feel more like myself.”

In 2019, Tamil Nadu became the second State in the country, after Kerala, to set up a clinic exclusively for transgender people at RGGGH, and later, at Government Rajaji Hospital in Madurai, offering free gender affirmation surgeries. In fact, RGGGH had been performing free surgeries for transpersons since 2009, but they were conducted as part of general outpatient services. “The gender clinic ensures that all services are available under one roof, so transpersons don’t have to go from one place to another to receive gender-affirming care,” says M. Sugumar, head of the plastic surgery department at RGGGH, who is also in charge of the gender clinic. His team includes Senthil Kumaran, assistant professor in the department of plastic Surgery at RGGGH, and a postgraduate resident.

As of 2024, the hospital has performed 171 gender affirmation surgeries for transmen and women, which include penectomies, breast implants, and mastectomies, among other procedures. More than 1,500 trans persons have sought care at the clinic, as of 2024. There was a drop in the number of surgeries during the COVID-19 pandemic, as most outpatient services were shut. However, since then, the number of surgeries has increased, says Dr. Sugumar. He attributes this rise to the progressive policies of the State government, as well as growing awareness and education within the transgender community.

The clinic, which operates on Fridays from 9 a.m. to 1 p.m., houses a psychiatrist, an endocrinologist, a venereologist, a physician, and plastic surgeons. “A transperson who visits the clinic is first referred to the psychiatrist. After several rounds of counselling, the endocrinologist evaluates the hormonal aspects, and the physician, the physical aspects. The venereologist ensures the person’s sexual health, and the plastic surgery department performs the surgery,” explains Dr. Sugumar. Each surgery may cost between ₹1.5 lakh to 3 lakh in private hospitals.

Trans people aged 18 and above are eligible for surgery, but doctors work with them for about a year to ensure they are certain about proceeding, as the surgery is difficult to reverse. “It’s a time-consuming process, but it’s necessary. Doctors need to ensure we are fully prepared for surgery,” points out Mr. John, an accountant.

However, Jaya, a transgender activist and general manager of Sahodaran — an NGO that works for the welfare of the LGBTQIA+ community — says the length of the process can be a barrier for many in the community, especially those who have left their natal families in order to undergo surgery. “Some transpersons may have left their homes with very little savings to support themselves during the process. While due diligence is important, there should be better mechanisms in place to support transpersons during this period of transition,” she adds.