Lesbian, gay, bisexual and transgender (LGBT) people in Kerala face legal and social difficulties not experienced by non-LGBT persons.

[1] It became one of the first states in India to establish a welfare policy for the transgender community and in 2016, proposed implementing free gender affirmation surgery through government hospitals.

[2][3][4] Same-sex sexual activity has been legal since 2018, following the Supreme Court ruling in Navtej Singh Johar v. Union of India.

of NCT of Delhi found Section 377 and other legal prohibitions against private, adult, consensual, and non-commercial same-sex conduct to be in direct violation of fundamental rights provided by the Indian Constitution.

On 28 January 2014, the Supreme Court dismissed a review petition filed by the Central Government, the NGO Naz Foundation and several others against the ruling.

[20] On 6 September 2018, the Supreme Court unanimously struck down Section 377 as unconstitutional, ruling that it infringed on the fundamental rights of autonomy, intimacy, and identity, thus legalising homosexuality in India, including in Kerala.

[26] In 2014, the Indian Supreme Court ruled to recognize a "third gender" in the case of National Legal Services Authority v. Union of India, affirming the transgender community's freedom from discrimination and right to equality.

A lack of training means that many government hospitals cannot offer gender affirming surgery, so patients must instead go to costlier private institutions.

[34] In 2017, the clothing brand Red Lotus hired two transgender people to model their sarees, Maya Menon and Gowri Savithri.

The proposal for the clinic was put forward by the District Legal Services Authority (DLSA) after a campaign had voiced health concerns for the transgender community.

[39] The suicide of Anannyah Kumari Alex, Kerala's first transgender RJ and activist, alleging botched-up gender affirmation surgery lead to protests by the LGBTQIA+ community of Kerala and initiated discussions about the irregularities and the absence of a specific protocol for conducting gender affirmation surgeries in various private hospitals of the state.

Despite Kerala being the most literate Indian state, ignorance concerning homosexuality was very high; with few LGBT people opting to come out, in fear that family members would "take them to a psychiatrist or file a police complaint against friends.

Gay conversion therapy is widely practised by both licensed psychiatrists/psychologists as well as quacks despite position statements by multiple psychiatrist/psychologist organisations condemning the practice as unscientific and illegal.

[56] In the 2021 Mathrubhumi Youth Manifesto Survey conducted on people aged between 15 and 35, majority (74.3 %) of the respondents supported legislation for same-sex marriage while 25.7 % opposed it.

Mainstream politicians like former Minister for social welfare, Dr. M. K. Muneer and K. M. Shaji have voiced their opposition multiple times with some of their statements being dubbed as 'hate speeches' by the media.

[59][60][61][62] Cyberbullying against the community and its supporters was reported to be at an all-time high with even Kerala Blasters Football Club and actor Mammootty were not being spared.