Karnataka High Court permits two transgender persons to continue hormone replacement therapy

The Karnataka High Court granted interim relief permitting two transgender women to continue their ongoing hormone replacement therapy (HRT), subject to the ...

What Happened

The Karnataka High Court granted interim relief permitting two transgender women to continue their ongoing hormone replacement therapy (HRT), subject to the final outcome of their writ petition challenging the Transgender Persons (Protection of Rights) Amendment Act, 2026.
Justice Sachin Shankar Magadum, while granting the interim order, noted that interrupting HRT mid-course could cause serious adverse physical and mental harm to the petitioners.
The petitioners had approached the court after their private hospital's doctors declined to continue prescribing HRT medications, citing apprehension about the newly inserted Section 18(g) of the 2026 Amendment Act.
Section 18(g) criminalises forcing any person to dress, present, or conduct themselves outwardly as a transgender person — and doctors feared this provision could be interpreted to apply to prescribing gender-affirming hormone therapy.
The petitioners further argued that the 2026 Amendment's revised definition of "transgender person" effectively excludes them from the protection and benefits of the parent Act.
A similar interim order protecting ongoing hormone therapy was passed by the Kerala High Court in April 2026, indicating a pattern of judicial intervention as challenges to the Amendment Act multiply across High Courts.

Static Topic Bridges

Transgender Persons (Protection of Rights) Act, 2019 — The Parent Framework

The Transgender Persons (Protection of Rights) Act, 2019 was enacted to prohibit discrimination against transgender persons and provide for their welfare. It established a self-perceived gender identity recognition mechanism, prohibited discrimination in education, employment, healthcare, and public life, and created a National Council for Transgender Persons.

The 2019 Act defined "transgender person" broadly — including trans-men, trans-women (regardless of whether they had undergone surgery or hormone therapy), genderqueer persons, and those with intersex variations.
The Act mandated government provision of healthcare services including sex reassignment surgery and hormone therapy.
The National Council for Transgender Persons advises on policy, monitors implementation, and redresses grievances.

Connection to this news: The 2026 Amendment narrowed this definition by removing the explicit inclusion of persons who have undergone hormone therapy or are genderqueer — creating ambiguity about whether HRT recipients remain protected under the Act, directly triggering the legal challenge.

The 2026 Amendment and the Definitional Dispute

The Transgender Persons (Protection of Rights) Amendment Bill, 2026 amended the parent Act in ways that civil society organisations and affected persons argued substantially narrowed its protective scope.

The Amendment removed from the definition of "transgender person" the explicit categories of: (i) trans-men or trans-women irrespective of whether they have undergone sex reassignment surgery or hormone therapy, and (ii) genderqueer persons.
It inserted Section 18(g) criminalising inducing a person to present outwardly as a transgender person — a provision critics argue is vague enough to chill medical professionals from providing gender-affirming care.
The Bill was passed amid significant criticism from transgender rights organisations, who argued it represented a rollback of hard-won protections.

Connection to this news: The definitional narrowing is the legal crux of the writ petition — the petitioners argue they no longer fall within the amended definition and that their doctors' refusal to continue HRT is a direct consequence of Section 18(g)'s chilling effect on medical practice.

Judicial Review and Interim Injunctions in Fundamental Rights Matters

When a law is challenged as violating fundamental rights, courts can grant interim relief — a temporary order maintaining the status quo or preventing irreversible harm — pending the final hearing on constitutional validity.

The standard for interim relief in constitutional challenges requires the petitioner to show: (a) a prima facie case, (b) balance of convenience favouring interim relief, and (c) irreparable harm if relief is refused.
Article 226 of the Constitution empowers High Courts to issue writs including mandamus, certiorari, and prohibition for enforcement of rights — the jurisdiction invoked in the Karnataka and Kerala cases.
Courts have increasingly recognised that gender identity and gender-affirming healthcare are aspects of personal liberty under Article 21.

Connection to this news: The Karnataka High Court's finding that mid-treatment interruption of HRT would cause irreversible physical and mental harm constitutes a classic "irreparable harm" determination — the standard basis for granting interim injunctions in health-related fundamental rights cases.

NALSA Judgment (2014) and Transgender Rights Jurisprudence

The Supreme Court's NALSA v. Union of India (2014) judgment recognised transgender persons as a "third gender," affirmed their right to self-identify, and directed the government to provide reservations and welfare measures for them as a socially and educationally backward class.

NALSA held that the right to gender identity is protected under Articles 14, 19, and 21 of the Constitution.
The judgment explicitly held that no medical intervention (surgery or otherwise) should be required for legal recognition of gender identity.
NALSA is the foundational precedent against which both the 2019 Act and the 2026 Amendment are being measured.

Connection to this news: Petitioners in the Karnataka case can invoke NALSA to argue that any statutory definition that conditions protection on the absence of hormone therapy contradicts the Supreme Court's affirmation of self-perceived gender identity and the right to access gender-affirming care.

Key Facts & Data

Statute challenged: Transgender Persons (Protection of Rights) Amendment Act, 2026.
Disputed provision: Section 18(g) — criminalises compelling outward transgender presentation; interpreted by doctors as chilling gender-affirming prescriptions.
Court: Karnataka High Court, Justice Sachin Shankar Magadum; interim order dated May 7, 2026.
Parallel case: Kerala High Court issued a similar interim order in April 2026.
Parent Act: Transgender Persons (Protection of Rights) Act, 2019 (No. 40 of 2019).
NALSA v. Union of India (2014): Foundational Supreme Court precedent recognising transgender persons' rights under Articles 14, 19, 21.
PRS India confirms the Amendment Bill removed explicit inclusion of persons who have undergone hormone therapy from the definition of "transgender person."