It can be difficult for many transgender and gender-nonconforming people to access essential and quality health care in New Hampshire. Nearly 1 in 2 transgender people nationwide reported experiencing mistreatment by medical providers in 2020, according to a report from the Center for American Progress.
James Rinker, a reporter at the Keene Sentinel’s Monadnock Region Health Reporting Lab, is taking a closer look at those barriers and what some are trying to do to help as part of an ongoing series. He recently joined NHPR All Things Considered Host Julia Furukawa to talk more about what he’s learned.
Transcript
James, can you tell us about the current state of what it's like to access gender-affirming health care and resources in New Hampshire? What have you been hearing from people?
A lot of them have spoken with me about, [saying] “I have a primary care provider, I have someone that I can go to for my routine health care, but they don't know about the other aspects of my care that I need help with, any knowledge about hormone replacement therapy or even just social affirmation.” A lot of people just don't have that knowledge on what this care actually is and how it plays into the health care aspect and everyone's daily lives.
I heard you mention earlier a routine care. There's this false narrative out there that gender-affirming care is elective. Could you break that down for us?
When it comes to gender-affirming care, a lot of misconceptions revolve around the medical affirmation aspect. People who are transgender or gender-nonconforming or nonbinary are seeking out hormone replacement therapy and surgical surgery to affirm their identity. But gender-affirming health care goes way beyond that in terms of mental health care, in dealing with symptoms of gender dysphoria and working with a mental health provider on how to feel comfortable in your own skin. A lot of that also has to tie in with social affirmation, from using their pronouns in these spaces to providing a safe space for parents and these kids and adults to ask questions about their gender identity. If someone wants to pursue medical affirmation — not all transgender people want to or will — but if they want to, providing the space and the resources to access this care, which has been scientifically proven to be safe, and it has been proven to be life-saving in a lot of cases.
What are some of the specific challenges that people are facing when they're trying to access gender-affirming care here in New Hampshire?
So in New Hampshire specifically, a lot of people have told me that with the lack of a public transportation system in place, or at least a robust one, they're having a much harder time accessing appointments, getting to surgery consultations, getting to even their basic primary care provider appointments. A big part of that is they're traveling greater distances because they don't have the access in their area. And that distance gets larger for rural trans people of color. A lot of people travel up to Dartmouth Hitchcock in Lebanon for their trans health center. And for myself and others who live in the Monadnock region, that's an over an hour [and] 15 minute drive alone. A lot of it is just, how can we even get to these appointments in the first place?
You reported that one organization here working to bridge this gap in care is the Gender Diverse Care Coalition of New Hampshire. What are they doing to expand access?
So the Gender Diverse Care Coalition of New Hampshire was started by three mental health providers in the state of New Hampshire: Harvey Feldman, Deb Horton and Xavier Quinn. What they did was start not only a coalition where providers could have a safe space to ask questions, they could receive training, they have quarterly meetings for health care providers across all specialties to destigmatize what it means to provide gender-affirming care. Harvey, when I spoke to him, said it best, of where it's not just the lack of number of providers — New Hampshire is facing a shortage of providers overall — but it's the lack of providers who have this comfort and this awareness of what this care is and how to provide an affirming space for their patients. They started a website that has a whole database, a whole library that's public, that has a list of providers via word of mouth recommendation or just further research. These are providers who are affirming and these are providers who have experience in this care. The goal of the coalition, through these training and consultations, is to expand this list beyond just specific medical affirmation like hormone therapy or any other surgery to affirm someone's identity, but also for your routine primary care.
How has the rise of legislation to restrict or ban gender-affirming health care in the state and across the nation impacted access here in New Hampshire?
It's impacted the perception of how people access this care. New Hampshire, while as of today, hasn't had any legislation that has been passed, the introduction of these bills has made it very difficult for providers to feel comfortable in providing this care in the first place. I've spoken with other providers in my work just off the record, on background, and they're worried. They're scared that their jobs are going to be illegal in the next few years, that they won't have a job. They're worried they're going to be persecuted for it. A lot of that has to do with bills around the U.S. being introduced and this misinformation that is then spreading in response to news reports on legislation. There's just a lot of misconceptions around it, and it's on the work of journalists, health care and health journalists specifically, to make it clearer on what this care is, how people are accessing it, and how our neighbors and our colleagues and our friends are being affected by it.
And as you continue this series, what other questions are you looking to answer?
A big thing that has popped up has definitely been, how are people just living their lives? There's a lot of reporting out there that focuses on the harm that we experience as queer people in the United States. And what I really hope to investigate more of, is the other side of that, the trans joy that people are going through. That it's not all bad. So everything from how gender-affirming health care access is a part of their life, but also sharing the stories of the trans and nonbinary and gender-nonconforming residents of the Granite State. In rural New Hampshire, especially, a lot of people don't personally know anyone who is trans. And it's about, if you don't know someone who is, how can I help you understand what we're going through and also understand the joy that we have in our lives?
