Social Distancing from Euphoria: A Queer/Trans perspective to Gender Affirmative Medical Interventions During the Pandemic

“Self-castration, suicide and waves of desperation are byproducts of the denial of sex hormones to inmates yearning to switch genders, advocates say.” I read out loud from a 2013 article [1] about the precarious predicament of transgender inmates in the US. My friend and activist, Doel Rakshit intervened, “Well yes, during the lockdown, I was repeatedly reminded that hormones are just a luxury that trans folks indulge in, it is not at all a necessity like food or water. Obviously, the fact that I could not look at the mirror or felt suicidal for months isn’t significant”, she smiled sarcastically. While Covid-19 and the subsequent lockdown have brought the world to a halt, people who are already marginalised had to pay the heftiest price for it. Transgender persons in India, who already face transphobia, discrimination, oppression, ridicule, and inaccessibility of resources, particularly felt the brunt of the lockdown, which led to massive unemployment and increased vulnerability. While ‘Stay at Home’ has been the mantra of 2020, home is rarely sweet or safe for LGBTQI+ folks. Stuck in queerphobic familial places, numerous transgender youths have reported “going back into the closet”. Some were forced to quit any form of gender affirmation in terms of self-identification and representation, for example wearing their attire of choice, keeping desired length of hair, etc. Reva, a trans woman, who lives in Mumbai and works in the IT sector, recalled how she was asked to “dress like a man” by her family members, in case she wished to return to her hometown during the pandemic.

Lockdown has rendered several transgender youths engaged in unorganised labour, such as sex work and begging, unemployed and devoid of any financial sustenance. Even those engaged in blue-collar or white-collar jobs have been victims of downsizing. Failing to find acceptance in their biological families, trans youth often reach out to their chosen communities of friends, mentors and allies, creating a quasi-family for emotional support. The sudden absence of community support and distancing from their ‘chosen family’ during the pandemic has added to the mental duress of trans youth. Economic dependence, lack of privacy, risks of mental, physical and sexual violence from family members, have also jeopardized the process of gender affirmative medical intervention (GAMI) for many trans youth. This has triggered several physical and psychological repercussions, including gender dysphoria. Doel talked about how the worsening dysphoria had made her increasingly homebound, to the extent that she couldn’t face another human being, not even the vegetable vendor outside her door. While in some cases, trans youth could not keep up with the expensive and difficult procedures of GAMI, in other cases they were forced to quit by families, and even became victims of conversion therapy.

Gender affirmative medical intervention comprises hormone replacement therapy (HRT) which typically involves estrogen, anti-androgen, anti-estrogen, and testosterone, etc. It also includes surgical interventions like vaginoplasty, phalloplasty, chest surgery, and voice surgery or other interventions like facial hair removal, voice modification etc. and last but not the least, mental healthcare. [2] These gender affirmation procedures require the careful intervention of experienced specialists, endocrinologists, surgeons and therapists, which is expensive and mostly unmaintainable for trans youth with limited social and economic means. The pandemic has worsened the scenario. Inaccessibility of medical supplies and professionals, online consultations, inability to ingest medicines, or even openly talk to doctors or psychologists in the vicinity of transphobic family members were some of the factors that came in the way of trans youth continuing GAMI.

Doel told me how several psychiatrists have reportedly denied providing ‘Gender Dysphoria Certificates’ which require thorough psychometric evaluation, leaving several people unable to start HRT in the first place. Resultantly, the risk of them performing unsupervised self-medication has increased manifold which may have severe consequences. HRT may have side-effects on the liver, kidneys, and the heart and might lead to complications associated with blood pressure, diabetes, and blood clotting etc. That’s why HRTs require associated healthcare, optimum dosages and rigorous monitoring. The effects of HRT are generally temporary. Suddenly stopping the therapy leads to hormonal imbalances, and therefore menopause-like symptoms. This includes osteoporosis, dwindling haemoglobin levels, weakness, and hot flashes, along with the obvious reversal of any progress towards gender affirmation.

All of this has led a lot of trans folks, who were already undergoing GAMI, to feel that they are involuntarily ‘de-transitioning’ where either their transition has stopped or almost completely reversed. Reva, who has been on HRT since 2018, reported that she lost touch with her endocrinologist for a long time during the lockdown. She missed basic but essential tests like blood sugar level, SGPT/SGOT etc, essential for monitoring liver function. While maintaining the expensive fees of an endocrinologist or a psychotherapist has been difficult for her, she couldn’t go to the government hospitals either, as she had previously been misguided by them, and noticed an overall lack of interest in the staff. Reva also reckoned how her skin and health worsened throughout the lockdown without her hormones and other medicines. Acne, rashes, body and facial hair, fatigue triggered her dysphoria to the extent where she felt extremely anxious and suicidal.

These concerns were echoed by Doel Rakshit and Shakti Waghela, another trans-activist from Mumbai. Throughout the lockdown Doel had to self-medicate because she lost the freelancing work which she had been using to fund her transition. Doel missed several of her scheduled tests to monitor hormone levels, electrolytes, liver functions, etc. as she couldn’t afford the INR 5000-6000 these would cost. It took her months before she could actually meet her endocrinologist, after which she could procure hormones in very small amounts. Adrij Basu, a transman from Kolkata, shared a similar experience. He has been self-injecting prescribed testosterone in order to avoid getting clinical assistance to reduce some expenditure. He had to miss his shots in the first couple of months, but later settled for a bulk purchase, which he thankfully could afford.

Shakti on the other hand, has not been able to afford to buy hormones since losing her job in February, 2020. Consequently, her mental and physical health worsened rapidly including facing cardiovascular issues. Her family, which is not supportive of her pursuing HRT, promptly blamed the hormones for her worsening health. In reality it was the absence of the correct dosages of her required hormones that led to her health issues. Shakti used to spend around INR 2000 a month on her treatment, which she now cannot afford. She has not seen her endocrinologist. Shakti has now resorted to self-medicating after watching the progress of her transition since 2018 in terms of body hair density, fat distribution, etc. slowly reverse and fade away. Shakti pointed out the need for the government to acknowledge the necessity of hormones for trans persons for which they have to bear an exhausting, ever-increasing financial burden.

Scheduled surgeries also got postponed with the lockdown in various cases. Doel was scheduled to get her orchiectomy in mid-2020. But, having run out of her savings, she cannot afford the procedure any longer. Similarly, Reva and Shakti both had to postpone their impending surgeries. Adrij however was able to get his double mastectomy in January, 2021 igniting a ray of hope, thanks to his family’s financial support.

While young trans folks are attempting to get back on their feet after the lockdown, the severe mental and physical damage that these months have had on them are irreversible. A lot of them have felt that the gender affirmation that they had achieved through their transition with GAMI before the pandemic, has been wasted. The time, labour and money they invested is not something they might be able to do again.

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[1] Briggs, Bill. “For Transgender Prisoners, Hormones Seen as Matter of Life and Death.” NBCNews.com, NBCUniversal News Group, 23 Aug. 2013, 02:28,

www.nbcnews.com/healthmain/transgender-prisoners-hormones-seen-matter-life-death-6C10981031.

[2] Deutsch, Dr. Maddie. “Information on Estrogen Hormone Therapy.” Information on Estrogen Hormone Therapy | Transgender Care, UCSF Transgender Care, July 2020,

transcare.ucsf.edu/article/information-estrogen-hormone-therapy#:~:text=Many%20of%20the%20effects%20of, absent%20fertility%20are%20not%20reversible.