Saroj, a 24-year-old transgender man from Itahari, Sunsari, has lived a life defined by the rigid binaries of society. Born biologically female, Saroj, who the Post is identifying with a pseudonym for privacy, knew from an early age that he identified as male.

For Saroj, menstruation was a monthly reminder of his biological reality, one that society relentlessly framed as ‘exclusive to females’. Without access to gender-affirming surgery but living as his true self, Saroj endured the pain and stigma in silence.

At 21, his periods became increasingly painful, accompanied by heavy bleeding. However, the thought of seeking medical help appeared daunting to him. The fear of being judged—a man explaining menstrual symptoms to healthcare providers—kept him away from hospitals for months. When the pain became unbearable, he finally visited a local health post, only to face ridicule.

“From the registration desk to the gynecologist’s office, I felt like a spectacle. People stared, whispered, even laughed,” Saroj said. The gynecologist’s reaction compounded his humiliation. “She dismissed my symptoms with taunts, saying, ‘Are you not a girl? Why are you dressing like a boy?’ I left without proper care, ashamed and angry.”

Even outside medical settings, Saroj’s experience was riddled with judgment. Local shopkeepers, aware of his transition, often mocked him when he purchased menstrual products. “You call yourself a boy, but why do you get periods?” they said.

This often forced Saroj to travel miles to find stores where he wouldn’t be questioned.

At 22, when his symptoms worsened, his family insisted he visit the hospital, dressing him in female attire to avoid confrontation. While he finally received treatment, the experience left him feeling dehumanised. “I felt like I was wearing someone else’s skin. My family meant well, but why can’t doctors and healthcare workers show kindness? Aren’t they supposed to treat everyone equally?”

His experiences shine a light on the gaps in education, awareness, and empathy around sexual and reproductive health and rights (SRHR) for not just transgender men but the whole of the LGBTQIA+ community.

Research proves this. According to a 2021 study, LGBTIQ individuals in Nepal face severe discrimination, social isolation, and human rights violations. These factors increased their vulnerability to HIV, compounded by stigma and family rejection for not adhering to traditional expectations like marriage and procreation.

Similarly, another 2020 study involving 340 MSM (men who have sex with men) and transgender women across eight districts in the Tarai region found alarming statistics: HIV prevalence was 5 percent among MSM and 13 percent among transgender women, while active syphilis affected 4 percent of MSM and 11 percent of transgender women.

Notably, 76 percent of transgender women engaged in sex work, and 51 percent reported discrimination in health care and various settings.

Despite Nepal’s constitution of 2015 guaranteeing fundamental rights for gender and sexual minorities—such as citizenship with gender identity (Article 12), equality (Article 18), social justice (Article 42), dignity (Article 16), freedom (Article 17), and reproductive health rights under the Safe Motherhood and Reproductive Health Act (2018)—these communities still face widespread stigma, discrimination, and inequality.

“They are often denied even the most basic rights promised by the law,” says Sarita KC, executive director of Mitini Nepal.

“Concepts like menstruation, safe motherhood, and abortion are typically associated with cisgender women, sidelining the diverse needs of individuals like transgender men, lesbian women, and bisexual individuals.”

KC adds that, while pregnancy can be relevant for queer individuals, they are unable to fully exercise their rights to services like IVF, surrogacy, and adoption, etc.

Surrogacy could be an option but was halted by the Nepal Supreme Court on August 25, 2015, and officially banned by a Cabinet decision on September 18, 2015, using the court’s ruling date as the cut-off. The Supreme Court’s final verdict, delivered on December 12, 2016, established that surrogacy is legal for infertile married Nepali couples, but illegal for single individuals, transgender couples, and foreign nationals.

According to KC, services like fertility counseling, egg freezing, sex education, and safer sex technologies remain unavailable, leaving queer individuals with little to no support. Hormone therapy for transgender individuals is also inaccessible.

Stigmatisation remains a major barrier preventing queer people from accessing healthcare, says KC. In November, the Post reported that many trans individuals experienced blatant discrimination at Janakpur Provincial Hospital.

Tabu Khan, one of the interviewees, recalled a ‘particularly humiliating’ visit six months ago for a syphilis injection. She described how the hospital staff treated her with extreme disrespect. “They asked about my condition in front of a crowd, made crude remarks about people like us, and humiliated me by forcing me to lift my sari for the injection in front of everyone,” Khan said.

“The limited access to SRHR for LGBTIQ people is not a minor issue,” says Laxmi Ghalan, chairperson of Mitini Nepal. “It hinders the full realisation of their human rights.”

Ghalan adds this includes violations of their rights to adequate living standards for health and well-being, equal treatment and non-discrimination, health and reproductive health, family life, dignity, privacy, and freedom of expression, association, and assembly.

“The community is also left out of policies, contrary to the principle underlying the Sustainable Development Goals, of ‘leaving no one behind’”, adds Ghalan.

KC further pointed out how transgender men are often denied uterine removal surgery, yet are required to undergo gender reaffirmation surgery for citizenship even if they face health or financial barriers. “We’ve seen cases where lesbians seeking uterus removal for health reasons are asked to bring their husbands....how unfair is that?”

Gender-affirming surgery surgery internationally requires medical professionals to follow certain clinical protocols. But in Nepal, the only relevant law, ‘The Human Body Organ Transplantation Act 1998,’ does not address gender reassignment. While some hospitals offer top surgery, bottom surgery is unavailable in Nepal.

With no clear legal framework for these procedures, sexual and gender minorities are forced to travel to India for expensive and risky surgeries, often facing physical, psychological, and legal challenges, KC said.

“We need to recognise that menstruation is not exclusive to women; anyone with a uterus can experience it. This should be incorporated into the educational curriculum,” said KC.

KC adds that the Nepal government should review, amend, and repeal existing health laws and policies that negatively impact the health and well-being of LGBT individuals. “It’s high time the government create a supportive legal and policy framework that prioritises the health needs of the LGBTIQ community, including HIV and STI prevention, treatment, and gender-affirmative care.”

A 2023 Mitini Nepal report, ‘Situational Analysis of SRHR Issues in LGBTIQ People’, involving several case studies of LGBTIQ people all over Nepal, recommends allocating health budgets to reduce out-of-pocket costs and providing subsidised insurance for sexual and gender minorities. Calls for legislation to recognise the family rights of same-sex couples and grant citizenship to children born to or adopted by LGBTIQs were another major point.

The report also called for “government-led research to gather data on LGBTIQ SRHR needs.”

“Despite my challenges with healthcare access, I don’t hold personal grudges against individual doctors,” Saroj said. “Their discriminatory attitudes may stem from a lack of awareness. I do hope healthcare workers make an effort to understand us, as hospitals are places of equal rights for all.”

Saroj added, “I hope the government initiates sensitisation and awareness programmes in hospitals to strengthen the capacity of healthcare providers to ensure confidentiality, empathy, and respect for us.”