Anirban Majumder, Debmalya Sanyal, Pramila Kalra, Somabha Bandopadhay, Kaushik Pandit
Recent amendments to the Transgender Persons (Protection of Rights) Act, 2026 have introduced changes in the legal definition, certification processes, and regulatory oversight of transgender identity in India, needing clarity on medical management of gender incongruent individuals. This position statement provides practical, evidence-based, and medico-legally sound guidance for endocrinologists to ensure continuity of care for individuals with gender incongruence within the evolving legal framework. The document emphasises the distinction between clinical care and legal certification and advocates adherence to internationally and nationally accepted standards, including World Professional Association for Transgender Health Standards of Care Version 8 and Endocrine Society guidelines, keeping in mind that the law does not forbid, prevent, or regulate through this act, as amended, the interventions by endocrinologists. It highlights strengthened penal provisions addressing coercion, inducement, and non-consensual interventions, underscoring the need for robust safeguards in clinical decision-making. Key recommendations include comprehensive clinical assessment, individualised risk-benefit evaluation, and meticulous documentation, particularly regarding informed consent, decisional capacity, voluntariness, and absence of coercion. The importance of confidentiality, alongside compliance with statutory reporting requirements, is also addressed. A practical distinction is made between continuation of established care and initiation of new interventions, with the latter requiring enhanced procedural diligence. The continuity of care in previously treated subjects is also emphasised. This guidance supports clinicians in delivering uninterrupted, ethical, and legally compliant gender-affirming care, reinforcing that patient-centred, evidence-based practice remains paramount, irrespective of legal definition concerns.