Practices for accessing hormone therapy in male to female transgenders in Maharashtra, India

Purpose: Hormone Replacement Therapy (HRT) is important for gender reassignment procedures for transgender persons in India. The study explores practices of male-to-female transgenders to access HRT for feminization procedures in Maharashtra, India. Methods: The first participant for this qualitative exploratory study was recruited from a community-based organization. Further participants were recruited using snowball sampling until data saturation was reached. Indepth interviews (IDI) were conducted over video platforms after written/audio-visual consent of the participants. The recorded interviews were transcribed into verbatim. The data, after each interview, were analyzed through thematic content analysis using inductive approach. The prevalent practices were identified from relevant phrases, sentences, and terms of the transcripts and were labeled and coded. Results: The study reported lack of acceptance and support from family for HRT. Some participants were abandoned or chose to run from their homes and undergoing transition without family support. Participants reported accessing HRT over-the-counter and practiced self-medication due to lack of affordability, scarcity of trained doctors and persisting stigma and discrimination at healthcare facilities. Those who self-medicated were following similar drug regimens administered to their peers or self-adjusted doses on the basis of physical achievements. Participants of Hijra kinships were dependent on their leaders to avail HRT services. Conclusions: There is a need to develop standard HRT guidelines for feminization procedures and include HRT services in health programs. There is a necessity to train healthcare professionals and establish a center of excellence for these procedures in Maharashtra.