What DGCA’s new medical guidelines prescribe for transgender persons

In a landmark move, the Directorate General of (DGCA) released new medical guidelines that will help persons who have completed their gender transition therapy or surgery to fly private and commercial .

The move is being seen as a positive development for the community, specifically India’s first trainee pilot, 23-year-old Adam Harry, who was declared unfit to fly by the in 2019 on grounds of life-long gender-change therapy.

In an earlier statement, issued on July 13, the had said an ongoing therapy wouldn’t be grounds for disqualification either, if they have reached a stable dose. This clause found no mention in the August 10 guidelines, however.

Here’s a quick look at the matter.

Who is Adam Harry?

Harry has a private pilot’s licence (PPL) from South Africa and had applied to convert it under regulations to be eligible to fly in India as a man. However, Group Captain YS Dahiya, who is the director of medical services in the DGCA, responded on July 27, 2020, with a mail confirming that Harry’s “fitness to fly” would not be assessed as long as he was on therapy, and requested him to review only after he was off hormonal medications.

Ministry intervention and DGCA response

After the matter was widely reported in the media, the Union Ministry of Social Justice wrote a letter to the DGCA on July 11, calling its policy discriminatory and a violation of the Transgender Persons (Protection of Rights) Act, 2019. The letter also demanded new guidelines for granting licences to transgender persons.

In response, the DGCA issued a statement on July 13 stating that “there are no restrictions on transgender people to obtain pilot’s licence and ratings; subject to the individual ensuring compliance of relevant provisions of age, educational qualifications, medical fitness, knowledge experience etc. among other things as specified in Aircraft Rules, 1937.”

The DGCA also included this statement by Dahiya: “Use of hormonal replacement therapy is not disqualifying if the applicant has no adverse symptoms or reactions. However, flying duties are not permitted while the dose of hormonal treatment is being stabilised or until an adequate physiological response has been achieved and the dose no longer needs changing.”

What DGCA said earlier

Earlier, the DGCA had also disputed Harry’s candidature on grounds of gender dysphoria (unease that a person may have because of a mismatch between biological sex and their gender identity). Besides the ongoing therapy, the DGCA had also cited Harry’s “mental health report” as incomplete since it was “endorsed by his treating endocrinologist and not by a specialised psychiatrist or psychologist”. Harry had submitted letters from both a psychiatrist and an endocrinologist.

However, the DGCA’s assumption that once a person transitions they would not need to take hormones is far from the reality of transpersons’ lives, many of whom must continue life-long hormonal therapy.

New policy: More restrictions?

The DGCA’s new policy offers much-needed clarity for its medical examiners when evaluating a transgender applicant’s medical fitness.

The assessment will be made on a “case to case” basis. The candidate will have to register for a preliminary medical test with the gender as per their ‘Certificate of Identity’ issued by the Government of India (male, female or transgender). They should also furnish reports from their treating surgeon or endocrinologist. They will then be declared “‘Temporary Unfit’ (by the preliminary test-takers) for a detailed evaluation at an Indian Air Force Boarding Centre and forward the application to DGCA.”

The medical assessor at the DGCA will also issue a ‘Temporary Unfitness’ letter and recommend further review only at the Institute of Aerospace Medicine, Indian Air Force (IAM, IAF).

At IAM, IAF, if the applicant has been taking hormone therapy or had a gender reassignment surgery within the last five years, they will be screened for their mental health status. They will have to submit detailed reports from the treating endocrinologist regarding the duration, dosage, and frequency of their therapy along with other info.

If the applicant is on hormone replacement therapy, they will be declared medically ‘unfit’ for at least three months and this duration can vary depending upon the risks of side-effects. Those who undergo surgery will be declared medically ‘unfit’ for at least three months or until a “complete clinical recovery has been achieved”.

Furthermore, the guidelines also mention that even after they are deemed medically fit, additional restrictions “may” be imposed. These will include a permit to fly only as first officers. In case they are the pilot-in-command, they should have a co-pilot who is either a senior captain and trainer or has more than 250 flying hours.

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