Abstract Background Legal frameworks governing identity are important determinants of population health, influencing Disability-Adjusted Life Years (DALYs) and progress towards the Sustainable Development Goals (SDGs). The Transgender Persons (Protection of Rights) Amendment Act, 2026 in India represents a shift from self-determined gender identity to a more regulated and medicalised framework. Methods This perspective paper presents a narrative public health analysis of the Transgender Persons (Protection of Rights) Amendment Act, 2026, drawing on published literature, policy documents and legal frameworks through a health systems and health equity lens. Results The amendment introduces additional medical and administrative verification processes, which may delay or obstruct access to gender-affirming healthcare. These barriers are likely to increase financial burden and contribute to unsafe or informal care pathways. The changes may worsen mental health outcomes, inclu
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