Since the country-wide lockdown came into effect, Sudeep Gautam, who identifies as a trans man, has not been able to get his hormone medication. Ever since his top surgery, a year ago, the 27-year-old has been dependent on hormone shots administered by a medical professional every 21 days to maintain a hormonal balance and prevent health problems. But the lockdown, which has now been in place for nearly a month and a half, has meant that he has had no opportunity to get his shots, which is leading to medical complications.

“I feel excessive agitation. There’s a burning sensation in my feet and I am suffering from hearing loss,” said Gautam. “All because of a lack of hormones in my body.”

Most transgender individuals who undergo gender reassignment surgery either need regular hormone shots or medication to balance their hormone levels once their reproductive organs are surgically removed or modified. These external hormones play a crucial role in helping their secondary sexual traits with their gender identity.

But like Gautam, the lockdown has deprived most transgender individuals of their hormonal medication, as the only medical services that are generally available are emergency care. For members for the LGBTIQ community, who are already more vulnerable to a host of medical, physical and mental issues, the lockdown has exacerbated existing problems and given rise to new ones.

Like most vulnerable groups affected by the lockdown, members of the LGBTIQ community, too, say that they are forced to compromise with their physical and mental health—with many suffering from withdrawal symptoms after a shortage of hormone medications and many others subjected to increased stigmatisation while being locked in with disapproving parents who condemn their sexual identities.

Pushpa Lama, a 37-year-old trans woman, has been undergoing withdrawal symptoms as hormone medication, which is generally imported from India, is unavailable in her area health post and pharmacies.

“It is tormenting to realise that I have to live with these symptoms unless the medicines are made available or until the lockdown ends,” said Lama.

Despite widespread controversies on the adverse health effects of hormone therapy, transgender individuals in Nepal largely rely on hormone replacement therapy drugs to attain their ideal body image. A qualitative study published in 2019 on hormone-using Nepali trans women showed that only a few sought doctors’ prescriptions for hormone therapy, but hormones were more likely to be bought from private pharmacies or brought in from abroad through friends.

But the problems aren’t limited to the trans community. Many other members of the LGBTIQ community report physical and mental anguish while locked in.

Trans individuals who mostly work in the entertainment industry, at bars and nightclubs, or as sex workers, have also been deprived of work and an income. This has forced them to leave the relative safety of cities like Kathmandu, Pokhara, Dharan and Biratnagar for their hometowns, or move in with their parents and partners. Many small towns are not as welcoming of different genders, sexual orientations or lifestyle choices as bigger cities.

“Many LGBTIQ people are being forced to move back to unsafe domestic spaces which had abandoned them after coming,” said Nagma Khan, a queer rights activist at Pahichan Nepal, an organisation providing tele-counselling to the queer community. “They are now spending their lockdown amidst hostility and loneliness.”

According to Khan, her organisation, which oversees operations in Province 2, receives at least four to five distress calls on a daily basis.

While domestic violence is often presumed to be higher in heterosexual relationships, studies have shown that the level of intimate partner violence in same-sex relationships is comparable, and sometimes, even higher. Countries across the world, including Nepal, have already reported a rise in domestic violence as the world goes into lockdown.

Activists from around the world are also concerned about the unavailability of support structures for the LGBTIQ community during the lockdown. With mental health already a big issue among the community, regular visits to safe spaces and conversations with mentors and others in the community can be critical to saving lives.

Globally, numerous organisations have come up with ways to provide support virtually or via the phone, as Pahichan is doing in Nepal. Stonewall UK, a UK-based queer rights organisation, campaigned for a #stayinforlgbt hashtag to create a safe space for LGBTIQ individuals to share their tips on staying busy during the lockdown. Organisations like the LGBT Foundation, Terrence Higgins Trust and Galop are holding workshops, events and support sessions via Zoom to stay connected with them.

But in Nepal, support for the community has been limited.

“We are worried that the lockdown is impacting not only physical but also mental and emotional health of our community,” said Bibek Susling Magar, programme officer at the Federation of Sexual and Gender Minorities Nepal. “In our country, even asking for help is stigmatised, particularly for people from marginalised groups. We are afraid that not many are reaching out for help due to a fear of being doubly stigmatised.”