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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By Sara Youngblood Gregory for Yes! Magazine.
Broadcast version by Kathryn Carley for Commonwealth News Service reporting for the YES! Media-Public News Service Collaboration
In December 2023, Pope Francis announced that Catholic priests may bless same-sex unions-as long as they do not resemble marriage.
Despite headlines heralding a radical shift, the declaration notes Church doctrine "remains firm" on its definition of holy matrimony as the exclusive province of heterosexuals. One month prior, the Vatican also announced that transgender people can be baptized.
Though inclusive steps forward at first glance, both announcements sidestepped any tangible commitment to LGBTQ people. The documents were stereotypically vague: Both blessings and baptisms are permitted only if they carry no risk of public "scandal" or "disorientation" among the faithful, terms that are not defined in the documents.
In short, the Vatican's "progressive" moves perpetuate a long-standing trend within Christianity, where LGBTQ Christians are expected to be grateful for the table scraps of a well-fed faith-or at least feel sated with the rancid "hate the sin, love the sinner" ethos popular across Christian denominations.
"It's no question that religion globally has been used as a weapon, especially against LGBTQIA persons," says teaching pastor and theologian Roberto Che Espinoza, Ph.D. "But religion actually is rooted in the practice of re-connection or binding together. The Latin root for the English word religion is religio," a noun referring to an obligation, bond, or reverence.
And there is no shortage of LGBTQ people of faith. A 2020 study by the Williams Institute at the University of California, Los Angeles, found that nearly half the country's LGBTQ population-5.3 million people-self-identified as a person of faith.
So can queer people still hungry for spiritual connection-especially those who revere Christian traditions-find religious communities that recognize queerness as a blessing, rather than a sin? An emerging group of queer and trans faith leaders, activists, on-the-ground organizers, and people who simply refuse to give up their faith are already answering that call, carving out affirming faith traditions, building tools to remediate religious harm, and proving that it's possible to build a queer church.
Sanctified Discrimination
For many LGBTQ people, disconnection is a defining element of their faith, with a third of religious LGBTQ adults reporting conflicts between their faith and identity in a 2013 Pew Research Center study. Many experience rejection for the first time via their faith communities, or at least learn that their identities are inherently dirty or impure. As of 2018, an estimated 700,000 people have undergone conversion therapy in the United States, a practice involving forcibly "changing" someone's gender or sexual identity. Though widely discredited-and illegal to subject minors to in 22 states-conversion therapy is still used in some religious settings. According to research from the Williams Institute, 81% of people who underwent conversion therapy did so at the hands of a religious leader.
Even for those who escaped the direct impacts of religious trauma, current U.S. politics are deeply intertwined with weaponized Christianity, making it nearly impossible to emerge unharmed as an LGBTQ person-personally, politically, or spiritually. The Republican party, which has long-standing ties to the Religious Right, is increasingly overt in its embrace of Christian nationalism-the belief that the U.S. should be a strictly Christian country. According to a 2023 survey by the Public Religion Research Institute and the Brookings Institution, more than half of self-identified Republicans currently sympathize with or explicitly adhere to Christian nationalism.
Christian nationalism goes beyond the desire to create a Christian theocracy. It's about creating a country where certain people are privileged and others-LGBTQ people, people of color, and those seeking reproductive freedom-are punished. "When we say Christian nationalism, it's white Christian nationalism," says Maureen O'Leary, director of field and organizing at Interfaith Alliance, a religious freedom and civil rights advocacy network. "It's white Protestant Christians that are being elevated."
That exclusionary ethos can be found throughout the modern Republican party, which is, not coincidentally, the beating heart behind much of the anti-LGBTQ legislation currently circulating. In 2023, more than 525 anti-LGBTQ bills were introduced nationwide, more than any other year on record, according to the Human Rights Campaign. Those bills included the implementation of Florida's high-profile "Don't Say Gay" policy, which restricts classroom discussions about sexuality and gender identity in public schools. Dozens of copycat bills have emerged since the Florida Board of Education approved the initial policy in 2022.
Florida, North Dakota, Missouri, Tennessee, and North Carolina all have restrictions on gender-affirming health care for minors, and at least five states are currently targeting gender-affirming health care for both minors and adults. Meanwhile, the Alliance Defending Freedom (ADF), a shadowy, right-wing legal organization, is using its deep pockets, allegiance to Christian nationalism, and wide reach to roll back civil rights in the courts. ADF is the legal powerhouse behind lightning-rod Supreme Court cases such as 303 Creative, Inc v. Elenis, where a self-proclaimed Christian website designer won the right to refuse to serve same-sex couples, in defiance of Colorado's nondiscrimination law, as well as the overturning of Roe v. Wade. Taken together, these attacks target the rights and dignities of queer, and especially trans, people on all fronts: restricting access to health care, public spaces like bathrooms, and education.
This discrimination is often legitimized through the guise of Christian morality and language. In practice, this frequently looks like portraying LGBTQ people, and progressive values more generally, as a threat to a Christian way of life. At the 2022 Conservative Political Action Conference, former president Donald Trump told the audience: "School prayer is banned, but drag shows are allowed to permeate the whole place. You can't teach the Bible, but you can teach children that America is evil and that men are able to get pregnant."
Meanwhile, Florida governor and 2024 presidential hopeful Ron DeSantis used the words of Jesus Christ to woo potential voters and call for a "war on woke"-or more accurately, a war on LGBTQ rights, diversity and equity initiatives, reproductive and voting rights, critical race theory, and education. While speaking to a group of roughly 10,000 evangelical college students in April 2023, DeSantis said, "Yes, the truth will set you free. Because woke represents a war on truth, we must wage a war on woke."
As these right-wing politicians demonstrate, "Christian nationalism is a political ideology," says Interfaith Alliance's O'Leary. "It's not a religious tradition." But the conflation of the two mean that many queer and trans folks feel exiled from their faith. A truly affirming church must do more than skirt extremism or offer conditional shelter for LGBTQ people. It must imagine a God, a faith, and a tradition that engages directly with justice and queerness.
Sacred and Strange
Rev. Naomi Washington-Leapheart, a Christian minister, movement organizer, and professor of theology and religious studies at Villanova University and Harvard Divinity School, reasons that a God who disregards the most vulnerable in service of the most powerful is not a God who will inspire a congregation to change a world that already reproduces cycles of dominance and dispossession. "An affirming, radically hospitable, justice-oriented congregation has to reject an idea of God that reinforces the very thing that causes exclusion and non-affirmation and injustice in our world," Rev. Naomi says. "The conceptualization of God in an affirming, justice-seeking space has to be, first of all, radically inclusive."
The Rev. M Jade Kaiser envisions God, and spiritual life more broadly, as something literally of the flesh: bodily, pleasure oriented, and inseparable from material liberation. In 2017, Rev. Kaiser and Rev. Anna Blaedel co-founded enfleshed, a spiritual community that publishes resources for collective liberation, including queer liturgies, a podcast on trans spirituality, and poems and anthologies exploring ritual, blessings, and identity.
"Our greatest gifts to the world will not come through acceptance from dominant systems or those constructions of 'God,' but in recognizing how sacred it is to be strange," says Rev. Kaiser. "There is so much God in how we create chosen family, love queerly, resist compulsory gendering, and collectively organize with pride that counters shame."
Sacred texts and traditions, too, are ripe for reconceptualization. Theologian Espinoza, for instance, believes creating radically inclusive faith practices requires more than just reconciling a faith tradition with sexuality. It also invites us to identify where these traditions are already queer via destabilized, counter-hegemonic, and counter-normative narratives. "Queerness is wild and feral," says Espinoza. "[It] is an undomesticable animal that we have not yet been able to contain or domesticate out of the tradition."
Traditions like communion, for example, have the potential for queerness, Espinoza explains. Christians all over the world consume the actual or symbolic body and blood of Christ, and in so doing, engage with the (trans)formative potential of the body. Recently, one of Espinoza's students risked their clergy credentials by serving communion in drag. "The student embodied God by feeding people bread and wine in drag," Espinoza recounts. "[It was] a wonderful reminder that we are bound by our materiality, but when we imagine another possible world, shit gets real!"
For others, revisiting religious texts also means questioning-and reimagining-what is considered sacred. For Della V. Mosley, a healing arts practitioner and counseling psychologist raised in a Black Baptist church in Illinois, exploring their connection to faith meant finding truth in alternative systems and spiritual homes. "For me, that path led to Black feminism, justice and liberation spaces, and a deep connection with nature," says Mosley. "These spiritual homes resonate more closely with who I am, the realities of the world today, and who I aspire to be." Recently, Mosley used Black feminist writings as sacred texts during a Sunday service at NorthStar Church of the Arts in Durham, North Carolina.
Some spaces imagine spirituality outside of specific religious affiliation or institutions altogether. At The Greenhouse, a grief and healing sanctuary for Black, Indigenous, and other students of color at Harvard, the point isn't to emulate or become a religious institution. Instead, co-founder Frances S. Lee, a pastor's kid who is now an ex-evangelical, says The Greenhouse fosters spiritual leadership and moral boldness for those who are barred from, or simply uninterested in, traditional religious authority.
"The Greenhouse invites us to access emotional safety, wonder, and belonging outside of religious institutions," says Lee. "At the foundational level, it is a refuge of tenderness, laughter, and meaningful silence." The community meets twice monthly and offers dinner, ritualized reflection, grounding exercises, and emotional release. Like Mosley and Espinoza, Lee makes spaces for queer and trans interpretations of Christianity, while also incorporating new sacred texts and traditions. They've taught trans spirituality and shape-shifting bodily presentations in their Christian classes and preached with Audre Lorde's 1978 essay "Uses of the Erotic: The Erotic as Power."
Taken together, these three tools-the reconceptualization of God, the queering of sacred texts and traditions, and the incorporation of alternate practices-form a sort of holy trinity on which a queer church may thrive. And much like queerness, this church, this connection with the divine, can happen anywhere: on a subway ride, in the pews, in passionate debate with your pastor. It may happen with music, in the silence of nature, in scripture, in a glance. It can happen while reading radical trans scholarship or Black feminist poetry. Queer church might look like a dance floor, a kiss, good sex. It may be reclaiming a saint or simply imagining Jesus at a gay bar.
New Sacred Spaces
Spiritual organizer Bex Mui's queer church began on Instagram. Raised Roman Catholic by her Polish mother and introduced to Buddhist principles by her Chinese father, Mui left the church at 20, in large part due to her burgeoning queerness and growing critical eye toward religion. To manage her grief, Mui threw herself into LGBTQ activism.
"As a professional speaker and trainer, I delivered 'the Word' of gender terminology and the rituals of creating safe spaces," says Mui, who works as an LGBTQ equity consultant. But by 2020, Mui was burnt out. She knew she needed to reconnect with not only her spirituality but with other queer people as well.
Beginning in January 2021, Mui got on Instagram Live every Monday to share prayers, spells, and astrology readings and use tarot as a tool for reflection, a ritual she called Queer Church. While discussing the power of a lunar eclipse in October 2023, Mui recontextualized interactions between Mary Magdalene and the newly risen Christ. "He's often interpreted as saying, 'Don't touch me,' a slut-shamey interpretation perpetuating the stereotype that [Magdalene] was dirty and unworthy of his love and attention," says Mui. "In reality and the truer Greek translation, he says, 'Don't cling to me.'" From Mui's perspective, in that moment, both the gospel and the eclipse were inviting people to let go of what is ready to leave.
Eventually, Queer Church expanded to become House of Our Queer, a sex-positive and people-of-color-centered community for spiritual exploration and well-being. House of Our Queer offers spaces and tools for spirituality, including workshops, rituals, and in-person community gatherings. And the community has responded. Mui says around 200 people tune in to Queer Church every week, and as many as 500 people attend the monthly Queer Magic Dance Party in Oakland, California.
The focus of both Queer Church and House of Our Queer is to support people who were raised religious, or feel curious about spirituality, and affirm that queerness isn't just part of religion but a blessing all its own. Rather than a set religious doctrine or denomination, Mui uses reclamation techniques-like adapting a Catholic prayer into a queer activist spell or honoring saints like Mary Magdalene-to affirm queerness and incorporate her religious upbringing.
"Whether I like it or not, I was raised Catholic, and that's a part of my culture. Reclaiming [my spirituality] started for me when I realized that I was actually putting a lot of effort into keeping that door shut," says Mui. "Queer Church is needed because queer people are human, and we need, just like everyone else, a place to gather for celebrations, shared ways to mark the passing of time, and places to turn to when we're in pain."
Sara Youngblood Gregory wrote this article for Yes! Magazine.
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