ALBUQUERQUE, N.M. — This summer, Sophia Machado packed her bags, left her home in Oregon and moved to Albuquerque, New Mexico, where her sister lives. Machado heard that residents there were more friendly to their transgender neighbors and that health care supported gender equality. Easier to access.
Machado, 36, is transgender and has good health insurance through work. Within weeks, she was able to attend a small primary care clinic, where her sister was already a patient, and the doctor was willing to refill her estrogen prescription and refer her to an endocrinologist.
She feels lucky. “I know a lot of the big medical facilities here have been hit hard,” she said.
Other patients seeking treatmentIn legally protected New Mexico, the situation is not so lucky.
After her primary care physician retired in 2020, Anne Withrow, a 73-year-old transgender woman who had lived in Albuquerque for more than 50 years, sought treatment at the University of New Mexico’s Truman Health Services Clinic, which specializes in transgender health care. “They said, ‘We have a waiting list.’ A year later, they still had a waiting list. A year later, before I managed to go back, I got a call,” she said.
But the caller was not from the clinic but a provider at a local community health center, who learned her name and was able to see her. Meanwhile, as of October, the state’s premier transgender health clinic remained at capacity and unable to accept new patients. Officials said they have stopped trying to maintain waiting lists and are instead referring patients elsewhere.
Over the past two years, as nearly half of states have passed legislation restricting gender-affirming health care, many transgender people have begun relocating to states that protect health care. But not all of these states have the resources to serve everyone. Cities like San Francisco, Chicago, and Washington, D.C., have large LGBTQ+ medical centers, but the high cost of living prevents many from settling there. Instead, many are choosing to move to New Mexico, which joins states such as Minnesota, Colorado, Vermont and Washington in banning gender-affirming health care.
But these newcomers are finding that trans-friendly laws don’t necessarily equal easy entry. Instead, they found themselves added to a long-running waiting list for care in a small state..
“With the influx of gender refugees and wait times getting longer, my doctor and I plan to get tested every two years,” Felix Wallace, a 30-year-old transgender man, wrote in a letter said the email.
T. Michael Trimm, who started working at the New Mexico Transgender Resource Center in late 2020, said the center gets two to three calls a month from people considering moving to the state. “Since then it has steadily increased to one or two a week,” he said. “We have people coming from Florida, Kentucky and West Virginia.” Not to mention families from Texas “wanting to commute here to get care, which is a whole other ballgame, trying to get it legal here but not in Care is illegal where they live.”
During the 2023 legislative session, New Mexico passed several laws protecting LGBTQ+ rights, including one that prohibits public agencies from restricting access to gender-affirming care.
“I’m very excited and proud to be in New Mexico, which has such a strong stance and is a strong sanctuary state,” said Molly McClain, a family medicine physician and medical director of the Deseo Clinic.at University of New Mexico Hospital. “And I don’t think it means more care is available.”
The U.S. Department of Health and Human Services has designated some or all of 32 of New Mexico’s 33 counties as health professional shortage areas. A 2022 report found that the state lost 30% of its physicians over the past four years. The state is expected to have the second-largest physician shortage in the nation by 2030, and it already has the oldest physician workforce. Most providers of gender-affirming care are located near Albuquerque and Santa Fe, but 60 percent of the state’s population lives in rural areas.
Even in Albuquerque, waiting lists to see a doctor are long, which can be difficult for patients who need urgent care. McLean noted that rates of self-harm and suicidal ideation can be extremely high for transgender people who are not yet able to fully express their identity.
Still, Trim added, “trans people can be very resilient.”
He said some transgender people have to wait many years to get transition-related medical care, even though “they’ve known it their whole lives.” While waiting for care can be painful, he hopes waiting lists are “more bearable than the thought that you might never get care.”
New Mexico has become a haven for patients seeking abortion care, with many surrounding states criminalizing abortion in the past two years. But McLean noted that providing gender-affirming care requires longer-term considerations, as patients will need regular check-ups for the rest of their lives. We’re “working very hard to make sure it’s sustainable,” she said.
As part of that effort, UNM’s McLean and others partnered with the Transgender Resource Center to launch a gender-affirming care workshop to train providers across the state. They particularly hope to reach people in rural areas. The program started in June with about 90 participants in biweekly meetings. McLean estimates that about half of them come from rural areas.
“This is part of primary care, that’s always been my mantra,” McLean said. Because New Mexico protects access to care, she sees more primary care providers motivated to offer puberty blockers, hormone therapy and other services to transgender patients. “The real focus is on enabling people to feel comfortable and confident delivering gender care wherever they are.”
Providing gender-affirming care in New Mexico still faces significant logistical challenges, said Anjali Taneja, a family medicine physician and executive director of Casa de Salud, a primary care clinic in Albuquerque.
“Some companies simply refuse to provide [malpractice] Taneja said Casa de Salud has long provided gender-affirming care, but it was only this year that the clinic found malpractice insurance to treat transgender youth.
Meanwhile, reproductive health organizations and providers are trying to open a new clinic in southern New Mexico that will also provide gender-affirming care, with $10 million coming from the state Legislature. Planned Parenthood of the Rockies will be part of that effort, and although the organization does not yet provide gender-affirming care in New Mexico, spokesperson Kayla Herring said it plans to.
Machado said the vitriol and hatred directed at the transgender community in recent years is horrifying. But if there’s anything good to come of it, it’s that the uproar has brought attention to trans stories and health care, “so these conversations are happening rather than something you have to explain to your doctor,” she said. “I feel very lucky to be here because I feel like it’s a lot safer here than other places.”
This article was supported by the Journalism and Women’s Workshop Health Journalism Fellowship and was supported by the Commonwealth Fund.
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