Mental Health Impact of Gender Transitioning: A Case Study of Hijras in Mumbai (India)

Background: Significant health disparities exist for hijras (male-to-female transgender individuals) in India, including higher rates of distress, psychiatric disorders, and poly-psychological health conditions. The process of gender transitioning, in particular, is a stressful event marked by a range of psychosocial and biological changes. There is limited understanding of the impact of gender transitioning on the mental health of hijras.

Methods: The study employed an integrated theoretical framework of sexual minority stress and social identity to explore experiences of transitioning among hijras in Mumbai, India. The study encompassed a qualitative life history calendar approach to explore gender transitioning as a critical life experience in a chronological manner and capture the intersecting nature of the experiences of self at developmental time points of twenty self-identified hijras.

Results: The participants presented a diverse perspective of their experiences of living as hijra, and understanding of transitioning. Biological family was often stated as a factor towards restricting or delaying transitioning, while gharana, guru and other hijras were listed as the social support available during the process. The participants also differed on reasons for transitioning, expectations, type of transitioning practices, issues of access, support and care. Majority of participants listed greater economic-ability and peer-influence as reasons for initiating transitioning, and use of non-prescribed hormone pills and injection. The participants also presented vulnerabilities, social anxieties and stress associated with the process of transitioning, and also varied level of satisfaction.      

Conclusion: Gender transitioning was found as an integral part of their experiences as hijras, which is considered an essential health service to help transgender individuals develop a physical body congruent with their gender identity. The salience of this period is known, as hijras often go to great lengths to achieve gender congruence. The gaps in health care access and service availability, and social support need to be addressed.