23 Year old Adam Harry had always dreamt of becoming a pilot, and he resiliently worked hard, beating the odds to become India's first trans male pilot.
And yet, despite having completed his training, Adam's dreams never took off. The reason – the Directorate General of Civil Aviation (DGCA) deemed him 'unfit to fly' on the grounds of gender dysphoria and hormone therapy.
Two years on, Adam is taking the DGCA to court.
On Friday, 8 July, the pilot will be filing a writ petition against the DGCA's decision to ground him based on his gender identity.
Does the DGCA's decision have any scientific basis? Can hormone therapy make one unfit for flying? What are the risk factors?
FIT asks experts.
Adam’s Story: What Happened?
In 2020, Adam was granted a scholarship by the Kerala Government from the transgender persons' welfare fund for pilot training at Rajiv Gandhi Aviation Academy.
However, in order to get his student pilot's licence, Adam had to undergo a medical examination as a female (his assigned sex at birth), because the system only allowed for one of two options - male and female.
Based on this evaluation, “they said due to gender dysphoria and hormone replacement therapy (HRT), I am not fit for flying,” he told the Quint's, Mythereyee Ramesh.
Can Hormone Therapy Make You Unfit for Flying?
Adam, like many trans men, is on female to male testosterone therapy (T therapy) which, to put it simply, suppresses estrogen and boosts your testosterone levels to induce physical masculine features and traits.
“Every person has a sex hormonal system," Saher Ali Naaz, who is a cardiovascular perfusionist, and a transwoman, tells FIT.
"Some people may have to take it artificially. Not only with Adam (a transman), but some cisgender men and women may also have to take hormones artificially."Saher Ali Naaz, Cardiovascular Perfusionist
This is especially true for those with hormonal imbalance, and women with conditions like PCOD, etc.
Adding to this, Dr Ambrish Mithal, Chairman, Endocrinology and Diabetes, Max HealthCare tells FIT, "Here you’re replicating what would’ve happened in a man’s body. You’re giving that hormone from outside, externally."
"I don’t see why there should be a disqualification."Dr Ambrish Mithal, Chairman, Endocrinology and Diabetes, Max HealthCare
Even so, speaking to the Quint's Mythreyee Ramesh, Adam clarifies that at the time of his medical examination, he stopped hormone therapy because he was being tested as a female, and yet it wasn't enough. His testosterone levels were higher than the standard levels for a female.
"So to make sure I cleared the test, I stopped my hormone therapy for six months. This was draining for me physically and emotionally. Any trans person can tell you this is not easy. But despite everything, my testosterone level was high and I did not clear the test."Adam Harry to The Quint
This then throws up the question, can excessive levels of testosterone make a person unfit to fly?
“There is some risk, I can say, when it comes to any person who is taking extra hormones. The key word is extra,” says Saher Ali Naaz. She also adds that such a risk can be easily detected by monitoring the person's blood.
"Every treatment can have side effects. You have to monitor liver function, blood counts," agrees Dr Mithal.
Dr Mithal goes on to say that excessive levels of testosterone can lead to high haemoglobin and high blood parameters. In rare cases, it can also lead to liver dysfunction. But, he adds, the risk is predominantly in those who are not being monitored.
"It’s not that you need very aggressive monitoring — we call these patients once a year or something, once they’re set. So I mean it’s like taking treatment for anything else."Dr Ambrish Mithal, Chairman, Endocrinology and Diabetes, Max HealthCare
"If they (DGCA) found some abnormalities in this testing, then I can understand," he says.
Even then, says Dr Mithal, "that’s a purely medical thing which can be handled by adjusting the dose, and changing the kind of therapy. I don’t see why there should be a disqualification"
Adam tells the Quint that he doesn't have any underlying liver or heart condition from his hormone therapy or otherwise.
“It would make sense if he had any serious medical issues which can affect his work, but these hormones can’t affect his work.”Saher Ali Naaz, Cardiovascular Perfusionist
What About Gender Dysphoria?
Adam also says that he was put through a psychometric test, which found that he has gender dysphoria - another reason cited by the DGCA for rejecting his flying licence.
They have, however, not given an explanation for this, or how 'gender dysphoria' renders him unfit to fly.
"Unfortunately, gender dysphoria exists as a mental health diagnosis in the DSM, and all of us who work in the field of gender, sexuality and mental health know that it is not a disease. You do not treat dysphoria, you provide care for the person to live their gender."Pooja Nair, Psychotherapist
"One of the fallouts of this is that because it is listed as an illness, the DGCA is able to say 'you have an illness', because it is a diagnosable condition."
Even if it was a 'diagnosed illness', how would it impact a person's ability to fly?
"That is the question that needs to be asked, and I'm sure they won't have a satisfactory answer, that isn't transphobia," says Dr Nair. Because gender dysphoria isn't debilitating like say anxiety disorder or PTSD may be for a pilot.
"It (gender dysphoria) is not debilitating in the way it is made out to be," she says.
"Now dysphoria is debilitating in the way that it is experienced because the person's quality of life reduces. It doesn't affect my capacity to do functions. Its not like if I have dysphoria I will not be able to know how an airplane functions."Pooja Nair, Psychotherapist
"The distress from gender dysphoria is being used to say that you don't have the skill or talent needed for this work,"she adds.
Beyond India: What International Regulations Say
This isn't just the case in India. Transphobic gatekeeping permeates aviation institutions the world over, often requiring candidates to jump through several hoops of rigorous psych evaluations just for being transgender.
In fact, activist groups like NGPA have been advocating for equal rights, and providing medical assistance, and legal help to members of the LGBTQ community in aviation around the world.
In the US, for instance, after much pushback, the Federal Aviation Administration (FAA) only recently changed their rules so that such evaluations are no longer categorically imposed on transpeople on top of the regular medical tests that all pilots have to undergo.
The Road Ahead for Adam & Trans Rights
"As long as they see it as an illness, they can make the case that it is debilitating in a particular way,"says psychotherapist Pooja Nair.
She goes on to say that things won't change till the idea of reasonable accommodation in workplaces is considered more seriously.
"It becomes a question of what can be done to support you to do the work for which we have hired you?" she says.
"Instead of seeing it like that, its like saying if you can't stand for too long, we will not give you a chair. Instead of seeing it as something that is needed for Adam to be a really good pilot, you are saying, because of all these one two three reasons he cannot be a pilot."Pooja Nair, Psychotherapist
Unfortunately, transphobia is baked into the medical system, and there's little that people in the community can do to circumvent it.
"To access affirming care, people are having to get this (gender dysphoria) as a diagnosis, so medicine and the whole medical community has set it up in a way that you have to admit to this illness and be diagnosed with this illness in order to get a 'cure', that is hormone therapy, surgery etc." says Pooja.
Not one to be beaten, Adam, however, is taking on this system.
"I want the DGCA to stop comparing bodies...Instead, look at a person's qualification. Don't snatch away someone's professional dream, because some other person is uncomfortable."Adam Harry tells the Quint.
He has since talked about how distressing the whole ordeal has been for him, especially now that he decided to challenge the DGCA's decision in court.
“I know mentally everyone gets distressed when they work hard to achieve something and without a valid reason someone is denying them the opportunity to live their dream," says Saher.
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