Evidence and Autonomy, Not Convenient Politics, Should Guide Our Care of Trans Children

This article responds to a Times of India opinion piece published on January 3, 2026, that argues for restricting gender-affirming care for children and adolescents. The column by Dr Janhavi Nilekani reiterates several familiar claims that have historically been used to delegitimise trans lives and deny access to medically recognised care. What follows is a point-by-point response to those arguments, grounded in clinical experience, research and queer-trans affirmative practice.

The Times of India column on “rethinking” gender treatment for children relies on arguments that are neither new nor evidence-based. These claims have circulated globally for decades and have been repeatedly refuted by trans communities, by medical research, and by professionals across health and psychosocial disciplines. Yet such views continue to find space in mainstream media, often without adequate scrutiny of their assumptions or harms.

Important rebuttals by Rit Prasanna and Dr Aqsa Shaikh have already addressed several of these concerns.

In the interest of transparency and accountability, I will share who I am and why I write this piece. I am a mental health practitioner (MHP) based in Mumbai with 15 years of therapeutic work with queer and trans clients. I am a gender nonconforming cis woman, I am queer, and I have engaged with queer-trans activism and rights for over 20 years. I am the co-creator of the Queer Affirmative Counselling Practice (QACP) course, which I continue to teach and co-author of the QACP Resource Book for Mental Health Practitioners in India by Mariwala Health Initiative (MHI).

Here’s what the Times of India article – and many others like it – get wrong, and why they are anti-trans:

1. Encouraging India to follow suit with the bans on puberty blockers by countries like the US and UK

It is crucial to see these developments in the context of rising global backlash against trans rights and hate for trans people, particularly in these countries. There is a severe, global backlash against trans people and their rights. This backlash and curtailing of rights and access to life-saving gender affirming care is fuelled by the US and the UK. Given their documented rollbacks on trans healthcare and rights, are we seriously looking at these countries as role models on how to support and promote trans rights in India?

On November 25, 2025, the World Professional Association for Transgender Health (WPATH) issued a statement condemning the New Zealand government’s decision to restrict access to puberty blockers. The statement states, “Puberty blockers are an important medical intervention (...) this ideologically driven ban ignores clinical experience, established international practice, and the medically necessary needs of transgender people and the families who care for and love them.”

2. On the claim that transness is a state of mind that can be ‘corrected’ with loving care

The column urges readers to not affirm “the child’s belief that they were ‘born in the wrong body’,” by giving them puberty blockers. This refusal to recognise the authenticity of genders other than cis is anti-trans. The belief that certain individuals decided to become women from men, or vice versa, is a deeply problematic understanding of transness. It ignores the violence of gender assignation at birth, where families and doctors gender a child based on external genitalia without any real knowledge of what the child’s gender actually is. Trans children are forced to live in the wrong gender because the medical establishment and families made a mistake and assigned them an incorrect gender. This reflects a broader unwillingness to acknowledge the violence of incorrect gender assignment at birth.

3. On puberty blockers ‘creating’ trans children

The argument relies on the false assumption that transness has a cause and, therefore, can be prevented or cured. This pathologising lens pops up several times in the article. It is claimed that loving care and a denial of puberty blockers are best for the child. Best in what way? So that the child can continue to experience dysphoria and live in their wrongly assigned gender?

The effects of puberty blockers are reversible. If trans children use puberty blockers and then move forward to access gender affirming care (GAC), it is because they are trans and they need that. It is not a cause-and-effect situation. Gender-affirming care responds to trans identity; it does not produce it.

The WPATH commissioned Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, is a substantial document covering all essential aspects of transgender health and care across different age groups. Chapters 6 and 7 focus on adolescents and children with clear recommendations on when and how puberty blockers and supportive GAC should be given. Two of the five principles underlying these standards include 1) childhood gender diversity is not a pathology or mental health disorder and 2) conversion therapies for gender diversity in children (i.e., any “therapeutic” attempts to compel a gender diverse child through words, actions, or both to identify with, or behave in accordance with, the gender associated with the sex assigned at birth) are harmful and we repudiate their use.

4. Conflating distress with dysphoria

To interchangeably use distress and dysphoria is anti-trans. Gender dysphoria is a uniquely trans experience brought on by the messed-up gender system we have created in our society and by forcing people to fit into binaries. Trans children and adults experience deep suffering because of gender dysphoria. It peaks during puberty. To resolve some of the dysphoria, medical intervention is necessary.

There is research from knowledge sources that are evidence-based and lived-reality-based that exists, pointing to the life-saving benefits of puberty blockers and GAC. Puberty blockers are used with cis children too, by the way. But as long as those interventions help conform to and enhance cis gender ways of doing gender, they are encouraged, for example, in the ‘treatment’ of ‘precocious puberty’. GAC that is available to cis children is being denied to trans children.

5. Framing care as danger

“Should children and young adults experiencing distress about their sexed bodies be able to access powerful drugs and surgeries with irreversible and life-altering consequences, substantial evidence of harm, and no credible evidence of benefit?” writes Nilekani. This framing is problematic for several reasons. One, trans children are referred to as persons ‘experiencing distress about their sexed bodies’, as if transness is a bodily condition that can be treated. Two, dysphoria has been minimised to a general feeling of distress. Three, medical interventions have been made to sound dangerous by calling them powerful drugs. Four, affirming gender changes have been incorrectly framed as life-altering consequences. Five, all research that documents the benefits and life-saving impact of GAC on trans people has been disregarded.

If we were to reword this question as, “Should trans children and young adults experiencing gender dysphoria be able to access medical interventions that are life-saving, in accordance with WPATH’s Standards of Care, that are both ethical and have demonstrated significant benefit based on preliminary evidence?”, then what would our answer be? It should be a resounding yes.

Adult authority is repeatedly used to override the realities of trans children. The column claims a concern for trans kids. What it really implies is, “Save trans kids by making sure they don't become trans.” Trans kids know early on how violent adults, families, neighbourhoods and schools are. Adults make repeated attempts (often violent) at gender correction of children to fit assigned gender. Most trans kids know their gender realities at an early age, but are the adults listening when the kids are telling them? Or are adults using their power to deny them crucial GAC? In my work with trans clients, a loving and supportive environment has meant that parents and family members have believed in their transness and supported their trans journeys through consistent support within the family, through queer-affirmative mental health services and medical interventions. They have stood by them to help them transition to their true genders.

6. A preoccupation with fertility and sexual function is ableist and heteronormative

“Medicalised transition in childhood can permanently compromise fertility, sexual function, and long-term physiological development.” This quote exposes a limited understanding of bodies and sex, of intimacies and pleasure, of fertility and child-rearing. There exists a multiplicity of bodies, genders, sexualities and ways of loving and living that cannot be fathomed within the narrow confines of marriage.

7. The blame on mental health establishment for supporting trans clients

The claim that distress (in trans people) is often immediately interpreted through the lens of gender identity, overlooking clinical symptoms, ignores the fact that the diagnosis of clinical conditions is a completely separate investigation that should be done if clinical symptoms are present. Transness is not a clinical category, and gender identity disorder should not exist. Unfortunately, currently, the only way for trans people to access gender affirming care is through first getting themselves diagnosed. This is the fault of the system.

Life saving gender affirming care should be medically accessible and available without a diagnosis. Competent MHPs who have trained themselves in queer and trans affirmative mental health care are able to understand the distress and unique life stressors that trans people face in a hostile society. They are able to support trans people in accessing GAC. This includes assessing if clinical symptoms are present, assessing for dysphoria, providing detailed information about risks, benefits, fertility effects, pre and post care, and provision of letters/ certificates required for surgeries.

Trans affirmative MHPs rely on LGBTQI+ community-generated resources to provide the best care for their clients. For example, many MHPs use Orinam’s letter of support that clearly states “He/she is legally an adult, his/her cognitive functions are normal, and he/she has the capacity to consent to medical care, including understanding of risks, benefits, and fertility effects of required procedures.”

8. An expert view on medical research without evidence

Unsubstantiated claims about lives on the margins come from a complacent place of privilege. All the data being quoted is incorrect. Just one source – WPATH – would have been enough to get the facts right.

Historically, medical and psychiatric knowledge has often marginalised trans voices, making it essential to critically examine whose evidence is treated as authoritative. Their standpoint is almost always anti-trans since they are invested in maintaining a cis-heterosexual society. Medicine and mental health care have historically been anti-trans. One has to carefully whet the research we look at to support our claims.

9. Evidence, caution and protection becoming tools to dismantle rights, agency and access

Invocations of ‘evidence’, ‘caution’ and ‘protection’ are used to justify restricting trans people’s autonomy. “India should insist on the same standards of evidence, caution, and child protection in GAC that it demands in every other area of medicine.” The approach to children and people on the margins is paternalistic and demonstrates an inability to believe in their autonomy, bodily integrity or agency. It effectively closes the doors on trans persons being able to access gender affirming surgeries and care that are life-saving. Every medical intervention has risks and benefits. There are protocols that uphold patients' rights, informed consent, success rates and the like. Doctors undertake critical life-threatening surgeries on patients’ brains and hearts. But when it comes to offering gender affirming surgeries, these same protocols are being used against trans people. An argument for not providing essential life-saving medical interventions to trans people is being put forth under the garb of protecting trans people.

10. Repeated misgendering of trans people

It is 2026, there is Google and thousands of resources on how to correctly gender trans people. Trans men and trans women are described using language that centres assigned sex rather than affirmed gender, reflecting a fundamental misunderstanding of gender identity. What is the difficulty in simply using the terms trans men and trans women? This points to misgendering and trans erasure.

In India, there is a longstanding cultural presence of trans people, a dynamic history of trans-rights activism and legal rights, government policies supporting trans people and a decade of queer-trans affirmative mental health care. Any discussion of trans healthcare must engage with this context, with evidence, and with the lived realities of trans people – rather than reproducing fear-based narratives that cause tangible harm.

Shruti Chakravarty (PhD) has 20 years of experience in the non-profit sector, as a mental health practitioner, researcher and trainer. She is Chief Advisor at Mariwala Health Initiative (MHI) and also faculty at the Queer Affirmative Counselling Practice course run by MHI.

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