ALBUQUERQUE, N.M. — This summer, Sofia Machado packed her bags and left her home in Oregon to move to Albuquerque, N.M., where her sister lived and where, Machado had heard, the residents were friendlier to their transgender counterparts. neighbors and gender-affirming health care was easier to access.
Machado, 36, is transgender and has good health insurance through her job. Within a few weeks, she was able to get into a small primary care clinic where her sister was already a patient and where the doctor was willing to fill her estrogen prescription and refer her to an endocrinologist.
She felt lucky. “I know a lot of the larger medical facilities here are pretty hard hit,” she said.
Other patients seekingin New Mexico, where access is protected by law, were not so lucky.
After her primary doctor retired in 2020, Ann Withrow, a 73-year-old trans woman who has lived in Albuquerque for more than 50 years, sought care at Truman Health Services, a clinic specializing in transgender health care at the University of New Mexico . “They said, ‘We have a waiting list.’ A year later, they still had a waiting list. A year later, before I could go back, I got a call,” she said.
But instead of the clinic, the caller was a provider from a local community health center who had gotten her name and was able to see her. Meanwhile, the state’s flagship transgender health clinic is still at capacity as of October and unable to accept new patients. Officials said they have stopped trying to maintain a waiting list and are instead referring patients elsewhere.
In the past two years, as nearly half of states have passed legislation restricting gender-affirming health care, many transgender people have begun moving to states that protect access. But not all of these countries had the resources to serve everyone. Cities like San Francisco, Chicago, and Washington D.C. have large LGBTQ+ health centers, but the high cost of living prevents many people from settling there. Instead, many have chosen to move to New Mexico, where restrictions on gender-affirming health care are prohibited, along with states like Minnesota, Colorado, Vermont and Washington.
But these newcomers have discovered that transgender-friendly laws don’t necessarily mean easy access. Instead, they find themselves added to ever-growing waiting lists for care in a small state with a long.
“With the influx of gender refugees, wait times increased to the point that my doctor and I were scheduling appointments every two years,” Felix Wallace, a 30-year-old trans man, said in an email.
When T. Michael Trimm started working at the Transgender Resource Center of New Mexico in late 2020, he said, the center received two or three calls a month from people who were considering moving to the state. “Since then it has steadily increased to a pace of one or two per week,” he said. “We’ve had people from as far away as Florida, Kentucky and West Virginia.” That’s not to mention families in Texas “who want to travel all the way here for care, which is a whole other can of worms, trying to access care that’s legal here , but illegal where they live’.
In its 2023 legislative session, New Mexico passed several laws protecting LGBTQ+ rights, including one that prohibits public authorities from restricting access to gender-affirming care.
“I feel really excited and proud to be here in New Mexico, where there is such a strong position and such a strong sanctuary state,” said Molly McClain, a family medicine physician and medical director of Deseo Clinic, which servesat the University of New Mexico Hospital. “And I also don’t think it means having to worry much more.”
The U.S. Department of Health and Human Services has designated some or all of 32 of New Mexico’s 33 counties as health care worker shortage areas. A 2022 report found that the state had lost 30 percent of its doctors in the previous four years. The state is on track to have the nation’s second-largest physician shortage by 2030 and already has the oldest physician workforce. The majority of providers offering gender affirming care are near Albuquerque and Santa Fe, but 60% of the state’s population lives in rural areas.
Even in Albuquerque, waiting lists to see any doctor are long, which can be difficult for patients desperate for care. McClain noted that rates of self-harm and suicidal ideation can be very high for transgender people who are not yet able to fully express their identity.
However, Trim adds, “trans people can be very resilient.”
Some trans people have to wait many years to get transition-related medical care, even “when they’ve known it their whole lives,” he said. While waiting for care can be painful, he hopes the waiting list is easier to bear “than the idea that you might never get the care.”
New Mexico had already become a haven for patients seeking abortion care, which was criminalized in many surrounding states in the past two years. But McClain noted that providing gender-affirming care requires longer-term considerations, as patients will need to be seen regularly for the rest of their lives. We’re “working really hard to make sure it’s sustainable,” she said.
As part of that work, McClain and others at the University of New Mexico, in partnership with the Transgender Resource Center, launched a gender care workshop to train providers across the country. They want to reach especially those in rural areas. The program began in June and had about 90 participants in each of its two-week sessions. McClain estimates that about half of them are from rural areas.
“It’s long been my mantra that this is part of primary care,” McClain said. Because New Mexico has protected access to care, she sees more primary care providers motivated to offer puberty blockers, hormone therapy and other services to their trans patients. “The point is really to empower people to feel comfortable and confident providing gender care wherever they are.”
There are still significant logistical challenges to providing gender-affirming care in New Mexico, said Anjali Taneha, a family medicine physician and executive director of Casa de Salud, an Albuquerque primary care clinic serving uninsured and Medicaid patients.
“There are companies that categorically refuse to provide [malpractice] insurance coverage for clinics providing gender confirmation care,” she said. Casa de Salud has long offered gender confirmation care, but, Taneja said, only this year did the clinic find malpractice insurance that will allow it to treat trans youth.
Meanwhile, reproductive health organizations and providers are trying to open a new clinic — one that will also offer gender confirmation care — in southern New Mexico, with $10 million from the state Legislature. Planned Parenthood of the Rockies will be part of that effort, and while the organization doesn’t yet offer gender confirmation care in New Mexico, spokeswoman Kayla Herring said, it plans to.
Machado said the malice and hatred directed at the trans community in recent years is frightening. But if anything good has come out of it, it’s the attention the buzz has brought to trans stories and health care, “so that these conversations are happening instead of it being something you have to explain to your doctor,” she said. “I feel very lucky that I was able to come here because I feel much safer here than in other places.”
This article was supported by the Women’s Journalism and Symposium Health Journalism Fellowship, with support from the Commonwealth Fund.
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