Background <p>Despite numerous efforts to implement inclusive policies in Kerala, transgender and gender-diverse (TGD) individuals continue to face institutional discrimination, resulting in significant challenges in accessing health care. Existing literature highlights the need for actions to expand the availability and utilisation of health care services for these individuals to prevent institutional erasure. This study aimed to identify the barriers health care faced by transgender people in Kerala.</p> Methods <p>A mixed-methods approach was employed, combining a cross-sectional survey among 120 TGD individuals for quantitative data and in-depth interviews among 13 TGD individuals for qualitative insights.</p> Results <p>This study examined barriers to healthcare access among transgender people in Kerala, using Levesque et al.‘s framework. Participants (mean age 33 years) included transwomen, transmen, and gender-fluid individuals. Key barriers included the limited functionality of the specialised TGD clinics, a perceived lack of awareness and responsiveness among health care workers, and experiences of discrimination. Financial constraints further restricted access to hormone therapy and gender-affirming surgeries. Structural barriers, such as the absence of gender-neutral facilities and inadequate admission protocols compounded these challenges. Participants emphasised the need for health care worker training and the expansion of public provision for gender-affirming care to address these barriers.</p> Conclusion <p>The identified barriers are deeply rooted in the social position of the TGD community, necessitating an approach that acknowledges the social determinants of their health to achieve meaningful improvements in health care access.</p>