Heather Johnson spoke to four doctors before she found one who would keep her on the hormone regimen she had been on for years. Four. Each of the others told her they could not prescribe anything, that she would need to wait for an endocrinologist, and that the wait was ten months long. Going cold turkey for ten months, she explained, is like "major depression on steroids", "a constant neurological pain," a "deep brain fog and malaise" that affects everything. That is not a side effect of transition, but what happens when you take hormones away from someone who needs them. The fifth doctor understood that, and kept her prescription going while she waited. One doctor in five.
Heather's story is the one that anchors this piece from Searchlight New Mexico, and I think it deserves to sit at the centre of it for a moment before we talk about policy, because what she is describing is not a failure of law. New Mexico has done the legislative work. Governor Lujan Grisham signed the Reproductive and Gender-Affirming Health Care Freedom Act in 2023, and the state sits among at least eighteen with a shield law protecting access to care for trans people of all ages. The framework is there. The intention is there. And Heather still spent months hunting for a doctor willing to prescribe her progesterone.
Protection and access are not the same thing
Paige Zamora, 25, an event coordinator in Albuquerque, put it more precisely than most policy documents do: "Having protections is still a step below properly investing into it." She is grateful, she knows the landscape in other states, but she also notices that trans healthcare "gets swept under the rug a bit," treated as the difficult issue nobody wants to look at directly. She is right, and it matters that she said it plainly.
Adrien Lawyer has been doing this work in New Mexico since 2008, when he co-founded the Transgender Resource Center of New Mexico. In all that time, he told Searchlight, there have never been enough providers. There are no surgeons performing genital surgery in the state. At most, three or four people have offered top surgery for transmasculine patients at any one time, and sometimes as few as one. A state that has written the right laws still cannot field enough practitioners to meet the need, and the people who cannot access care here are already the ones who moved here to escape states that have banned it entirely.
The training gap is the root of this
Dr Kim Nguyen, an internal medicine physician and a founding board member at Comunidad de Colores, a free clinic in Santa Fe that will provide gender-affirming care when it opens later this year, describes what happens when medical education simply leaves this out: "If you haven't been trained in it, it can just feel very new." She trained in San Francisco, where the resources were there. Most of her colleagues did not. And when you are already seeing twenty to thirty patients a day, picking up an unfamiliar area of practice is genuinely hard, even when your instincts are good.
Lawyer is blunter about it. You can complete nurse training, physician assistant training, a full medical degree, he says, without a single hour of cultural education about trans people, let alone clinical training. "I think it goes all the way to the bottom," he told Searchlight. He is right. This is not a failure of individual doctors; it is a curriculum failure that has compounded over decades, and it shows up in every consultation where a doctor says "I can't prescribe you anything" not because they object but because nobody ever taught them that they could.
Nguyen says it is actually fairly straightforward to incorporate gender-affirming care into primary practice, at least at the beginning. Which makes the gap all the stranger, and all the more frustrating. The knowledge is not arcane. The barrier is not complexity. It is just absence, an absence of training, an absence of exposure, an absence of anyone deciding that this population deserves to be part of standard medical education.
The federal picture is making this harder
New Mexico's shield law cannot insulate the state from everything happening federally. Proposed rules from the current administration would strip Medicaid reimbursement from providers offering gender-affirming care to minors, and could block Medicaid and Medicare funding entirely from hospitals that provide the care at all. One medical professional told the Searchlight that if those rules take effect, hospitals in New Mexico would likely stop providing care for trans youth. That is not hypothetical, hospitals in other states have already paused care in response to federal pressure, and the Colorado Supreme Court had to order the state's largest provider for under-eighteens to resume treatments after it stopped.
Then there is Texas Children's Hospital, where the Department of Justice secured a $10 million settlement and required the creation of what it is calling the nation's first "detransition clinic." Heather Johnson, watching this, says what a lot of trans people are thinking: if they have managed to do it once, they will try to roll it out further. Detransition is a real experience for a small number of people, and those people deserve care and compassion. Using a settlement to mandate a clinic framed around reversing transition is a different matter entirely. It is policy shaped to send a message, not to meet a clinical need.
What good care actually looks like
Heather moved to New Mexico from Missouri partly to get away from anti-trans legislation. She had accessed hormone therapy through her university's student health service, which she described warmly as having doctors trained in gender-affirming care. When she graduated and needed to transfer her care to a primary care physician, the system failed her repeatedly before it held. She had the skills and persistence to navigate that. She knows not everyone does. Someone without her resources, her knowledge of the healthcare system, her capacity to keep trying, could have gone months without hormones that they needed. She called it a potential "death sentence" for someone in that position, and that is not hyperbole. Abrupt withdrawal of hormone therapy causes real harm.
The American Medical Association describes gender-affirming care as vital to the physical and mental health of trans people. Research links access to care among young people with lower rates of depression, anxiety, and suicidal ideation. None of this is fringe or contested within mainstream medicine. The barriers Heather and Paige and the people Adrien Lawyer has spent seventeen years supporting are facing are not clinical barriers. They are structural ones, and structural problems have structural solutions: training, funding, investment, and the political will to treat this population as one that deserves care.
New Mexico is trying. The legal framework is genuinely good. The intention of the people working in this space, the clinic Dr Nguyen is helping to open, the resource centre Lawyer has run for nearly two decades, is genuine too. But good law and good intention, without the bodies and the budgets to back them, leaves people counting doctors until they reach number five.