After years of struggling to access gender-affirming healthcare, Ayesha found refuge in the Mitr clinic initiative only to lose it when funding was halted.
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“It was an emotional moment for me. Just the fact that a counsellor cared to ask me about my preferred pronoun and name was just wow,” said Ayesha Meera Pathan, a 26-year-old trans woman from Guntur in Andhra Pradesh. It was early June 2022, and Ayesha had just arrived for her first consultation at the Mitr Clinic, a healthcare facility dedicated to serving transgender people in the Narayanguda area of Hyderabad.
By then, Ayesha had spent six years trying to begin her gender transition journey—but had encountered harassment, obstacles, and apathy at every turn.
The other hospitals and clinics that she had been to had always referred to her by her dead name (the name a trans person was given by their birth family and was mentioned in the initial documents. But the trans person prefers not to use it anymore and has adopted a new name that aligns with their gender identity). At the Mitr Clinic, the name on her identity card and other documents did not matter to the counsellor. All that held weight were Ayesha’s words.
“I can’t express how dignified the experience was for me,” Ayesha added.
The Mitr Clinic in Hyderabad was one of three such facilities that were set up—the other two being in Pune, and Thane—in 2021 as part of Project Accelerate, an initiative supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR).
According to a staff member of the clinic who spoke to queerbeat on condition of anonymity, the three clinics served 5200 clients over the last four years. 93 percent of them were trans women, four percent were trans men, and the remaining were non-binary individuals.
The clinics were operated as a collaboration between the Johns Hopkins University School of Medicine, the United States Agency for International Development (USAID), and the Indian government. In January 2025, Donald Trump, President of the United States, signed an executive order pausing all foreign aid for 90 days, pending a review.
This decision has caused numerous USAID-funded development programs around the world to cease operations—including the Mitr Clinics in India.
For Ayesha, the shutting down of the Mitr Clinic comes as a huge blow to her plan of gender transition. “I will get my surgery, but now it will be delayed significantly, I have to start from scratch, find new doctors, research about them, understand their techniques and if it is suitable for my health. There is a lot of labour in starting all over again,” she said.
Assigned male at birth, Ayesha said she didn’t fully understand her gender identity as a child. But she recalled always struggling to fit into binary structures that divided the world into males and females. She described the feeling as a “slight sense that something was not right.”
In her first year of college, Ayesha recalled experiencing a deep sense of discomfort with her own gender identity for the first time. Internet research told her that this feeling has a name—gender dysphoria—and that gender transition surgery could help align one's physical appearance with their gender identity. She said the possibility filled her with a sense of relief and hope.
Ayesha began identifying as a woman soon after that. But it took her another five years to embark on the journey of transitioning. “I began to feel suffocated by the life I was living,” she said. “I reached a breaking point and I decided to take a stand for myself.”
Over the next few years, she said she knocked the doors of nearly a dozen medical institutions, including governmental hospitals, private clinics, and medical colleges. All of them left her with distressing experiences.
“Even though they were doctors in well-established institutes, their knowledge about the transgender community’s needs was shockingly poor. They lacked basic empathy,” she said, the anger in her voice palpable. “I felt they treated me like shit.”
During a psychiatric evaluation at a reputed medical college in Andhra Pradesh, a junior doctor in the department held her hand and asked if she felt attracted to him. “Will this doctor behave the same way with a cisgender person?” she told queerbeat. “People think our lives are only about sex work and begging. It’s as if they can’t fathom that we have the same range of emotions and desires as any cisgender person.”
The lack of awareness among medical professionals extended beyond discrimination—it actively obstructed her transition. When she approached a major government hospital in Andhra Pradesh, an assistant professor at the psychiatric department told her that the institute did not have a psychologist qualified to take on her case. Instead of offering alternatives, they referred her to another medical college, which in turn told her they had never encountered a case like hers before.
“They refused to give me a Gender Dysphoria (GD) certificate and instead referred me to a psychiatric facility in Visakhapatnam,” she said. The certificate is a necessary prerequisite to accessing gender-affirming healthcare like hormone therapy and surgery.
Ayesha described the entire process as “exhausting, demoralising, and, above all, unnecessary.”
“It was an emotional moment for me. Just the fact that a counsellor cared to ask me about my preferred pronoun and name was just wow,” said Ayesha Meera Pathan, a 26-year-old trans woman from Guntur in Andhra Pradesh. It was early June 2022, and Ayesha had just arrived for her first consultation at the Mitr Clinic, a healthcare facility dedicated to serving transgender people in the Narayanguda area of Hyderabad.
By then, Ayesha had spent six years trying to begin her gender transition journey—but had encountered harassment, obstacles, and apathy at every turn.
The other hospitals and clinics that she had been to had always referred to her by her dead name (the name a trans person was given by their birth family and was mentioned in the initial documents. But the trans person prefers not to use it anymore and has adopted a new name that aligns with their gender identity). At the Mitr Clinic, the name on her identity card and other documents did not matter to the counsellor. All that held weight were Ayesha’s words.
“I can’t express how dignified the experience was for me,” Ayesha added.
The Mitr Clinic in Hyderabad was one of three such facilities that were set up—the other two being in Pune, and Thane—in 2021 as part of Project Accelerate, an initiative supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR).
According to a staff member of the clinic who spoke to queerbeat on condition of anonymity, the three clinics served 5200 clients over the last four years. 93 percent of them were trans women, four percent were trans men, and the remaining were non-binary individuals.
The clinics were operated as a collaboration between the Johns Hopkins University School of Medicine, the United States Agency for International Development (USAID), and the Indian government. In January 2025, Donald Trump, President of the United States, signed an executive order pausing all foreign aid for 90 days, pending a review.
This decision has caused numerous USAID-funded development programs around the world to cease operations—including the Mitr Clinics in India.
For Ayesha, the shutting down of the Mitr Clinic comes as a huge blow to her plan of gender transition. “I will get my surgery, but now it will be delayed significantly, I have to start from scratch, find new doctors, research about them, understand their techniques and if it is suitable for my health. There is a lot of labour in starting all over again,” she said.
Assigned male at birth, Ayesha said she didn’t fully understand her gender identity as a child. But she recalled always struggling to fit into binary structures that divided the world into males and females. She described the feeling as a “slight sense that something was not right.”
In her first year of college, Ayesha recalled experiencing a deep sense of discomfort with her own gender identity for the first time. Internet research told her that this feeling has a name—gender dysphoria—and that gender transition surgery could help align one's physical appearance with their gender identity. She said the possibility filled her with a sense of relief and hope.
Ayesha began identifying as a woman soon after that. But it took her another five years to embark on the journey of transitioning. “I began to feel suffocated by the life I was living,” she said. “I reached a breaking point and I decided to take a stand for myself.”
Over the next few years, she said she knocked the doors of nearly a dozen medical institutions, including governmental hospitals, private clinics, and medical colleges. All of them left her with distressing experiences.
“Even though they were doctors in well-established institutes, their knowledge about the transgender community’s needs was shockingly poor. They lacked basic empathy,” she said, the anger in her voice palpable. “I felt they treated me like shit.”
During a psychiatric evaluation at a reputed medical college in Andhra Pradesh, a junior doctor in the department held her hand and asked if she felt attracted to him. “Will this doctor behave the same way with a cisgender person?” she told queerbeat. “People think our lives are only about sex work and begging. It’s as if they can’t fathom that we have the same range of emotions and desires as any cisgender person.”
The lack of awareness among medical professionals extended beyond discrimination—it actively obstructed her transition. When she approached a major government hospital in Andhra Pradesh, an assistant professor at the psychiatric department told her that the institute did not have a psychologist qualified to take on her case. Instead of offering alternatives, they referred her to another medical college, which in turn told her they had never encountered a case like hers before.
“They refused to give me a Gender Dysphoria (GD) certificate and instead referred me to a psychiatric facility in Visakhapatnam,” she said. The certificate is a necessary prerequisite to accessing gender-affirming healthcare like hormone therapy and surgery.
Ayesha described the entire process as “exhausting, demoralising, and, above all, unnecessary.”
When Ayesha arrived at the Mitr Clinic three years ago, she was pleasantly surprised by how she was treated. Unlike the hostile and negligent environments she had previously encountered, she felt the staff at Mitr were well-trained and non-judgmental. Most importantly, they were helpful—they guided her through every step of her transition.
“Transitioning is not just getting surgery. It is an entire process of feminisation involving various steps,” she said, stressing the need for monitoring the body’s response at every stage.
The process began with psychiatric counselling, which explored her gender dysphoria. After seven sessions, Ayesha was given a GD certificate. Six months later, she began hormone therapy. “In the first month alone, they conducted numerous tests to monitor how my body was responding to the medication,” she said. “Every three months, and then every six months, they continued testing to ensure I wasn’t experiencing any severe side effects.”
Unlike what she had experienced, seen, and heard at other medical facilities, Ayesha felt Mitr’s approach to healthcare centred on patients’ needs. The difference was visible in how the clinic approached medical procedures and the kind of emotional support the staff offered. “Earlier, all my energy was spent searching for queer-friendly doctors. At Mitr, I didn’t have to go through that struggle alone,” she explained. “They were with me at every step.”
Part of the reason for the clinic’s success may have been the fact that trans persons were well-represented among the staff. “We always tried to hire all transgender staff,” said a doctor who was associated with the clinic. Speaking on condition of anonymity, the doctor added, “It is not always possible to find transgender doctors, but the Hyderabad clinic was lucky to have two of them. We also make sure we sensitise [external] doctors before adding them to our network and referring patients to them.”
Ayesha believed a key facet underlying Mitr’s success in caring for its patients was the absence of stigma. In Ayesha’s opinion, Mitr Clinic provided a vital alternative to the traditional healthcare system. She described how the nurses and staff at Mitr built trust with patients by giving them personal assistance, maintaining confidentiality, and creating a space free from stigma.
Mitr’s services were far more affordable than many alternatives. “When I had no job, I didn’t have to pay for doctor consultations here,” said Ayesha. “Outside, a single consultation costs at least ₹1,000. At Mitr, I got blood tests with a 50-70 percent discount, and HIV and VDRL (Venereal Disease Research Laboratory, a test for Syphilis) tests were free.”
The stark contrast in Ayesha’s expenditure speaks for itself. “I spent at least ₹30,000 at other facilities in three years before finding Mitr. Over the past two years, I have spent just ₹10,000 here,” she said.
While Ayesha has relied on Mitr primarily for accessing transition-related healthcare, the clinic also provided a range of other services including general health consultations, screening and treatment for sexually transmitted infections (STIs), mental health support, and assistance in accessing aid programs.
“Among our clients who had come to avail services for counselling or transitioning or laser treatments, 84 percent of them were first-time HIV testers,” said the same doctor who prefers to stay anonymous. The clinic regularly used these services as entry points to screen people for STIs and educate them about sexual health.
This is important because transgender people have historically been discriminated against and ill-treated at healthcare facilities which then leads to avoidance of seeking institutionalised healthcare. “In general hospitals, the behaviour of the staff and the tone in which they ask questions is often stigmatising. It can negatively affect a trans person’s mental health,” she said. “Many of us think, ‘If we have to die anyway, why should we endure this added humiliation?”
As Mitr shuts its doors, Ayesha recognised the immense privilege of having had access to affordable, trans-friendly healthcare through the clinic. She is aware that many others in her community remain trapped in cycles of exploitation and medical neglect.
The abrupt cessation of funding has affected not just the clinic’s clients, but its staff as well. “At the Hyderabad clinic, we were eight people from the transgender community who worked as staff, we are now left jobless,” said Rachna Mudraboina, a trans health consultant who managed the Mitr Clinic in Hyderabad.
Rachna, who has worked at the clinic since its inception, hopes to find alternative funding to revive the initiative. “If we find another funding opportunity we are thinking of opening a new clinic that will provide similar services. But it might not be the same depending on the kind of money we receive,” she said.
Mitr’s closure means that Ayesha’s future looks uncertain once more. She is forced to find new gender-affirming healthcare professionals, which she described as “starting from zero.”
“I am just exhausted by the thought of having to find a psychologist again, an endocrinologist, surgeons—all of whom are gender-affirming,” she said. According to an article published by the BBC, Hyderabad’s Mitr clinic offered care to 150 to 200 transgender patients each month.
Mitr Clinic was more than just a medical facility for trans people like Ayesha. It was a place where they did not feel isolated because everyone knew each other’s pain and understood or had experiences of navigating the same journey.
Ayesha desperately hopes a funder will turn up to save her best stigma-free healthcare option.
Writer
Ekta Sonawane (they/she/he) is a non-binary gender fluid journalist from Maharashtra.
Editors
Visvak (they/he) is a writer and editor, mostly of narrative nonfiction.
Illustrator
Jose (she/they) is a non-binary illustrator from Kerala whose work highlights personal stories marked by gender, body experiences, and their South Indian heritage. While not lost in their sketchbook, they can be found devouring all things camp and horror.
Producer
Ankur Paliwal (he/him) is an independent journalist, and founder and managing editor of queerbeat.
