The Transgender Persons Act, 2019 mandates that the government ensures medical facilities provide care to transgender persons (including for gender-affirmative procedures) and review medical curricula to address the health needs of transgender persons. However, despite the enactment of the law, many transgender and gender-variant persons in India struggle to access essential health care services. Legal provisions on health care strip them of their right to self-determination by setting up complex bureaucratic processes for the legal recognition of gender identity. In this article, I critically examine the health care provisions in the Act and the lack of efficient legal criteria for gender-affirming procedures, as well as the basic flaws in the medicalized model of legal recognition of trans persons' gender identity, which not only characterize the Act but also have serious implications for its implementation across the country.