Beyond the Binary: Understanding and Improving Care for Transgender Patients in Indian Intensive Care Units

Background: The care of transgender patients in intensive care units (ICUs) presents unique challenges that require specialized knowledge and sensitivity. In India, where transgender individuals face significant social, economic, and healthcare disparities, their experiences in critical care settings remain largely understudied and undocumented. Objective: This systematic review aims to synthesize available evidence regarding the experiences, outcomes, and specific healthcare needs of transgender patients in Indian ICUs, while identifying gaps in current research and clinical practice. Methods: A systematic search of electronic databases, including PubMed, Embase, Scopus, Web of Science, and Indian medical journals, was conducted for studies published between January 2000 and October 2024. Studies were included if they addressed transgender health care in critical care settings in India or provided relevant insights into transgender critical care that could be applied to the Indian context. Results: The review identified 18 studies meeting the inclusion criteria. Key themes emerged including barriers to accessing critical care, hormone management during critical illness, gender-affirming approaches in ICU settings, staff knowledge and attitudes, and unique clinical considerations for transgender patients. Limited India-specific research was available, with most studies being observational or qualitative in nature. Conclusions: This review highlights significant gaps in research, guidelines, and clinical practice regarding transgender patients in Indian ICUs. Addressing these gaps requires targeted research initiatives, development of evidence-based protocols, and comprehensive education for healthcare professionals working in critical care settings.