Identifying ones' gender and having that sense is typically developed by the age 4. It is not a conscious decision, but one aspect that makes each of us an individual. However, transgender people do not have a gender identity that matches with their body. Scientific studies indicate that transgender is more likely happens in utero where the fetal brain is differentiating into male or female brain.
In recent years, perception to look at transgender has changed or still changing in India. Additionally, in 2014, Rights Of Transgender Persons Bill was passed in 2014, which sought to end the discrimination faced by transgender people in India. Have you ever felt that you don't know how to care for a transgender patient?