By Cecilia Nowell for KFF Health News.
Broadcast version by Roz Brown for New Mexico News Connection reporting for the KFF Health News-Public News Service Collaboration.

This summer, Sophia Machado packed her bags and left her home in Oregon to move to Albuquerque, New Mexico, where her sister lived and where, Machado had heard, residents were friendlier to their transgender neighbors and gender-affirming health care was easier to get.

Machado, 36, is transgender and has good health insurance through her job. Within 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 refill her estrogen prescription and refer her to an endocrinologist.

She felt fortunate. "I know that a lot of the larger medical institutions here are pretty slammed," she said.

Other patients seeking gender-affirming health care in New Mexico, where access is protected by law, haven't been as lucky.

After her primary care doctor retired in 2020, Anne Withrow, a 73-year-old trans woman who has lived in Albuquerque for over 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 managed to go back, I got a call," she said.

But instead of the clinic, the caller was a provider from a local community-based health center who had gotten her name and was able to see her. Meanwhile, the state's premier clinic for transgender health is still at capacity, as of October, and unable to accept new patients. Officials said they have stopped trying to maintain a waitlist and instead refer patients elsewhere.

Over the past two years, as nearly half of states passed legislation restricting gender-affirming health care, many transgender people began relocating to states that protect access. But not all those states have 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 keeps many people from settling there. Instead, many have chosen to move to New Mexico, which has prohibited restrictions on gender-affirming care, alongside states like Minnesota, Colorado, Vermont, and Washington.

But those new arrivals have found that trans-friendly laws don't necessarily equate to easy access. Instead, they find themselves added to ever-growing waitlists for care in a small state with a long-running physician shortage.

"With the influx of gender-refugees, wait times have increased to the point that my doctor and I have planned on bi-yearly exams," 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 fielded two or three calls a month from people thinking about moving to the state. "Since then, it has steadily increased to a pace of one or two a week," he said. "We've had folks from as far away as Florida and Kentucky and West Virginia." That's not to mention families in Texas "looking to commute 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 bodies from restricting gender-affirming care.

"I feel really excited and proud to be here in New Mexico, where it's such a strong stance and such a strong refuge state," said Molly McClain, a family medicine physician and medical director of the Deseo clinic, which serves transgender youth at the University of New Mexico Hospital. "And I also don't think that that translates to having a lot more care available."

The U.S. Department of Health and Human Services has designated part or all of 32 of New Mexico's 33 counties as health professional shortage areas. A 2022 report found the state had lost 30% of its physicians in the previous four years. The state is on track to have the second-largest physician shortage in the country by 2030, and it 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 live in rural regions.

Even in Albuquerque, waitlists to see any doctor are long, which can be difficult for patients desperate for care. McClain noted that the rates of self-harm and suicidal ideation can be very high for transgender people who are not yet able to fully express their identity.

That said, Trimm adds that "trans folks can be very resilient."

Some trans people have to wait many years to receive transition-related medical care, even "when they've known this all their lives," he said. Although waiting for care can be painful, he hopes a waitlist is easier to endure "than the idea that you maybe could never get the care."

New Mexico had already become a haven for patients seeking abortion care, which was criminalized in many surrounding states over the past two years. But McClain noted that providing gender-affirming care requires more long-term considerations, because patients will need to be seen regularly the rest of their lives. We're "working really hard to make sure that it is sustainable," she said.

As part of that work, McClain and others at the University of New Mexico, in partnership with the Transgender Resource Center, have started a gender-affirming care workshop to train providers statewide. They especially want to reach those in rural areas. The program began in June and has had about 90 participants at each of its biweekly sessions. McClain estimates about half have been from rural areas.

"It's long been my mantra that this is part of primary care," McClain said. As New Mexico has protected access to care, she's seen more primary care providers motivated to offer puberty blockers, hormone therapy, and other services to their trans patients. "The point really is to enable 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 Taneja, 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 are outright refusing to provide [malpractice] insurance coverage for clinics doing gender-affirming care," she said. Casa de Salud has long offered gender-affirming care, but, Taneja said, it was only this year that the clinic found malpractice insurance that would allow it to treat trans youth.

Meanwhile, reproductive health organizations and providers are trying to open a clinic - one that will also offer gender-affirming care - in southern New Mexico, with $10 million from the state legislature. Planned Parenthood of the Rocky Mountains will be part of that effort, and, although the organization does not yet offer gender-affirming care in New Mexico, spokesperson Kayla Herring said, it plans to do so.

Machado said the vitriol and hatred directed at the trans community in recent years is frightening. But if anything good has come of it, it's the attention the uproar has brought to trans stories and health care "so that these conversations are happening, rather than it being something where you have to explain to your doctor," she said. "I feel very lucky that I was able to come here because I feel way safer here than I did in other places."


Cecilia Nowell wrote this story for KFF Health News.


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A staggering 93% of transgender teens live in a state that has enacted or proposed legislation that would restrict their rights, according to a new report from the Williams Institute at UCLA's School of Law. Utah was the first state this year to enact a bathroom ban, and that has led to some confusion as school districts aim to come into compliance.

Elana Redfield, federal policy director is one of the report's authors and says despite the law being what she terms "more measured," as it may permit some to use the corresponding restroom under limited circumstances, it doesn't mean it is less harmful.

"Even the mere fact of discrimination being debated, of laws being debated that might potentially result in a restriction of rights or access to services, that can have mental-health outcomes," she said.

86% of transgender and nonbinary youths say debates around anti-trans bills have negatively impacted their mental health, according to The Trevor Project. The Williams Institute report also found that some states with an existing law impacting access to bathrooms also had new or carried-over bills pending in 2024, that could further limit access. Redfield said the constant uncertainty that LGBTQ people face on a daily basis is taxing and can have serious consequences.

While Utah may also have a gender-affirming care ban and is currently having its transgender sports ban challenged in court due to provisions that are likely unconstitutional and violate Title IX, Redfield said she is pleased to see similar laws failing to pass, in many cases because of people-driven initiatives.

"We see a lot of power in state governments and we see this kind of inspiring example from reproductive rights. Arizona is a great example of people power and access to reproductive care, but also Kansas, when you see that the attempts to ban gender-affirming care have not been successful, and also attempts to ban abortion have not been successful in Kansas," she continued.

Redfield added it is important to highlight that half of all transgender youths in the U.S. live in 14 states and the District of Columbia that have enacted "shield" laws, which protect doctors and parents who have sought gender-affirming care for trans youth. She added that almost 200,000 trans teens now live in states that have banned conversion therapy, one of which is Utah.


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Some New Hampshire businesses and educators say legislation targeting LGBTQ+ students is harming both kids and the state's economy as it faces a critical worker shortage.

More than two hundred businesses recently signed on to a letter to Gov. Chris Sununu saying the steady drumbeat of bills targeting transgender youths in particular is tarnishing the state's reputation.

Michelle Veasey, executive director of New Hampshire Businesses for Social Responsibility, said the bills are shortsighted.

"When our families don't feel comfortable and aren't happy, our employees are moving to other areas," Veasey pointed out. "We felt it was important to help them to understand the economic side of these decisions."

Veasey argued discriminatory policies make it harder for companies to recruit new workers to the state or convince young people to remain in New Hampshire to pursue their careers.

The New Hampshire Senate has advanced legislation to ban transgender girls from playing on girls' sports teams as well as a measure requiring teachers to inform parents about their child's behavior at school.

While the bill does not single out LGBTQ+ students, educators say it would require them to share information regarding a student's gender identity or sexual orientation.

Linds Jakows, communications and digital director for Granite State Progress and 603 Equality, said too often, such students are forced into homelessness by disapproving parents.

"This bill could have really dangerous consequences for students for whom home is not a safe place right now," Jakows emphasized.

Jakows pointed out it meant the world to have a teacher in high school to come out to when it wasn't possible at home and schools should be a safe space for all students. Jakows added forcing teachers to record what they see and hear in the hallways erodes trust among students and could drive more teachers from the profession.

A new study suggests laws in New Mexico and 22 other states to protect school-aged LGBTQ youth are having a positive impact.

According to research by the Trevor Project, suicide attempts in states with specific protections for LGBTQ youth were 18% lower, and physical violence reported by those youth was 3% lower.

Katalina Hadfield, a member of Equality New Mexico's board of directors, said she believes the state's progressive protections are due to a community-centered culture.

"Where folks are really willing to help each other out, and look out for one another," said Hadfield. "And I think that is part of what helps students in a lot New Mexico schools feel more included."

In recent decades, New Mexico has seen prominent advances in gay and lesbian rights, where same-sex sexual activity has been legal since 1975.

Last year, a bill passed in the New Mexico Legislature to remove loopholes - and explicitly include local entities and counties to prevent discrimination and human rights violations.

The Human Rights Campaign says in 2023, more than 550 - a record number - of anti-LGBTQ bills were introduced across 43 states, and more than 80 were passed into law.

Both Florida and Texas are among the top ten for introducing and passing hostile laws.

Hadfield, who grew up in New Mexico, knows several people who have left those states because they feel unwelcome and scared.

"And when you travel there," said Hadfield, "even if you run into some nice people - if you get for some reason wrapped up in the criminal justice system there, or even something as simple as a speeding ticket, you get sucked into this government system that has legislated and made a policy choice to not respect trans people."

Results from the Trevor Project were published in the online journal LGBT Health. The findings are based on responses from more than 27,000 students ages 13 to 24, in 44 states.