Insane wait times and traumatizing visits. Why trans healthcare in N.J. still needs work.

Nathan Rodriguez lives two hours away from his primary care physician in Somerset County. Even though he has to take a full day off of work to make the four-hour round trip from his home in Atlantic County, Rodriguez, a transgender man, said it’s worth it.
“I go to this practitioner because she knows things about the trans community,” said Rodriguez, executive director of Trans Equity Coalition, a nonprofit run exclusively by transgender and nonbinary people. “She has stopped me from taking medications that would interact negatively with my hormones, things like that. So, I go to someone who is knowledgeable.”
Accessing medical care in the United States can be difficult for the average person, but it’s even more difficult for transgender and nonbinary patients seeking an outwardly accepting and informed provider, according to those with lived experience, physicians, and scholars who spoke with NJ Advance Media.
While New Jersey is considered a safe haven for LGBTQ+ healthcare, the transgender and nonbinary population continues to face barriers to even the most basic physical and mental healthcare, not to mention gender-affirming care. Beyond the challenges everyone faces accessing healthcare — finding adequate insurance, rising costs, transportation — transgender and nonbinary people confront gaps in knowledge, discrimination, harassment, and fear of physical assault, according to those with firsthand experience.
The COVID-19 pandemic exacerbated existing challenges, reducing access to gender-affirming resources and increasing mental health risks, according to a survey by the South Jersey Institute for Population Health. The survey of over 200 transgender and non–binary individuals living in South Jersey revealed significant mental health challenges, with 21% of trans men, 28% of trans women, and 58% of non-binary respondents experiencing significant depression.
The community also reported high rates of anxiety and 29% of participants said “fear of discrimination by my healthcare provider” was a primary barrier to attending medical appointments.
“Barriers to general medical appointments and mental health appoints, you are seeing that in the trans and nonbinary population, but on top of that is lack of access to gender-affirming providers, feeling confident in the provider they may already have, and feeling like they can trust their provider,” said Dr. Christina Goodwin, an assistant professor of psychiatry at Cooper Medical School of Rowan University who worked on the survey.
“I think that the anxiety comes from not being accepted for who they are — being misgendered at your mental health provider and being deadnamed and just not being respected,” said Goodwin.
The real or perceived threat of discrimination can prevent transgender people from getting medical care when they need it.
A nationwide survey of 93,329 binary and nonbinary transgender people found that many respondents avoided seeking medical care due to fear of discrimination. Nearly 1 in 4 respondents to the 2022 U.S. Transgender Survey did not see a doctor when they needed to in the last 12 months due to fear of mistreatment.
After several prior bad experiences at urgent care facilities near his home in South Jersey, Rodriguez said he avoided seeking care for complications he experienced from a hysterectomy performed out of state.
“I was going to be presenting very masculine coming in and saying, ‘Hey, I just had a hysterectomy, I’m having some complications,’” said Rodriguez, who takes testosterone. “I just suffered through it. I decided I’m not going to go and subject myself to that.”
The fear of discrimination is well-founded. The U.S. Transgender Survey found 48% of respondents who saw a health care provider within the last 12 months reported having at least one negative experience because they were transgender, such as being refused health care, being misgendered, having a provider use harsh or abusive language when treating them, or having a provider be physically rough or abusive when treating them,
Even if a provider unintentionally uses a deadname, as in calls a transgender person by their birth name instead of their chosen name, or inadvertently uses the wrong pronoun, it can be hurtful at best and damaging at worst.
“When deadnames crop up, when being misgendered crops up, it creates an immediate environment of lack of safety, of the perceived or real threat of harm,” said Aisling MacDonald, a transgender woman and project manager and trainer at Garden State Equality, the state’s largest LGBTQ+ advocacy and education organization.
“Do I believe that the provider is going to rob me of my life five minutes into the session?” MacDonald asked. “I don’t think so. But does it immediately make me feel like this is not a place where I can get care that I need outside of life-saving gender-affirming care? Yes.”
People who have a gender identity or expression that differs from their assigned sex may have to travel several hours to see a healthcare provider that’s openly LGBTQ-friendly and trained on best practices.
While New Jersey has LGBTQ+ affirming healthcare providers throughout the state, the majority of them are concentrated in North Jersey, where the bulk of the population and major medical facilities reside, according Garden State Equality’s Affirming Healthcare Map.
For instance, Robert Wood Johnson University Hospital Somerset is one of only two hospitals in New Jersey and one of only a handful in the Northeast to perform “bottom surgery,” a procedure that matches a person’s sexual organs to their gender identity, according to the hospital’s website.
“I just had a patient yesterday that we referred there who lives down the shore,” said Dr. Justin Schweitzer medical director of the Center for LGBTQ+ Health at Cooper University Health Care. “Talk about access to care. In probably one of the most densely occupied states in our country, there’s still issues accessing care.”
For many physicians, treating transgender patients might be new territory. Nearly 1 in 4 transgender adults who responded to the 2015 U.S. Transgender Survey reported having to teach their clinician about transgender people.
“I applied to get a hysterectomy and the person over the phone setting up the appointment kept going ‘OK, so your wife’ and I’m like ‘No, it’s for me,’” said Jason Wilkerson, a transgender man and volunteer with Trans Equity Coalition. “She said ‘I’m not in the mood for jokes’ and hung up the phone on me.”
Wilkerson said he called the office back and had to explain to a different person that “I’m a trans man. I do have a vagina.”
“They were like, I’m so sorry, they thought it was a prank call,” said Wilkerson.
The experience can be alienating and frustrating for transgender patients. The 2015 U.S. Transgender Survey found individuals who had to teach their clinician about transgender people had substantially higher levels of poor self-rated health and severe psychological distress than those who did not have to teach their clinician.
“It is fairly obscene to be asked as an individual trans person to be teaching your provider about how to best support you,” said Lucas Manrique, a project manager and trainer with Garden State Equality.
All of these obstacles exist in a state considered one of the most welcoming for transgender people. Last year, Gov. Phil Murphy signed an executive order that gives gender-affirming protections to adults and minors and prohibits the extradition of anyone in New Jersey to another state for providing, receiving, or facilitating gender-affirming health care services. The state also has strong anti-discrimination laws which protect sexual orientation and gender identity in a variety of circumstances like employment, housing, and public accommodations.
State Attorney General Matthew Platkin has sued school districts for adopting policies he says violate state discrimination laws and put gender non-conforming students at risk.
Thirty-two hospitals in New Jersey were named 2024 LGBTQ+ Healthcare Equality leaders by Human Rights Campaign Foundation, the third-most in the country.
But transgender people, medical professionals and experts say there’s more that can be done to ensure healthcare is accessible, welcoming, and affirming for transgender patients. Advocates say it’s especially important amid nationwide concerns that President-elect Donald Trump may roll back transgender rights.
Schweitzer said healthcare providers can challenge themselves to go the extra mile and train more full-time employees on how to provide LGBTQ+ affirming care.
“In the lectures I do, we talk about pronouns and definitions, but I also talk about why that’s important. So, we talk about health disparities and suicide risk for trans youth, which is especially high. We talk about HIV risk and how that’s higher in trans women of color,” said Schweitzer. “Thinking about it as this lifesaving healthcare regimen and not just pronouns.”
Trans Equity Coalition also provides training for doctors on how to treat transgender patients and teaches them how to run an inclusive practice.
“I hope that we’ll continue to make improvements because it’s not great, even with all the work that we’ve done,” said Rodriguez.
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Jackie Roman may be reached at [email protected].