The Montgomery County government could be doing more to support its transgender residents, a Jan. 16 report found, recommending that officials consider creating a resource center and lobbying the state to require cultural competency training for medical providers.
Council Vice President Kate Stewart (D-Dist. 4) commissioned the 57-page report created by the Montgomery County Office of Legislative Oversight (OLO) in early 2023. Stewart has taken on the lack of resources for LGBTQ+ residents in the county as a key part of her work as a councilmember.
“I think for so many in the community, [the report] validates their experience and it also provides us with more information that also validates what we heard from members of the community in the LGBTQ+ community survey that came out earlier this fall,” Stewart said. “While we’re a very progressive place and we’re trying to be a welcoming place for LGBTQ+ families, the report itself says we are a desert when it comes to these types of health services. We need to get behind these services and need to be doing much better.”
About 0.5% of Maryland’s adult population—24,000 people—is transgender, and an estimated 6,000 trans Marylanders rely on Medicaid, according to a study from the Williams Institute at UCLA. The same study estimates that around 8,000 Maryland children and teenagers are transgender.
While the county doesn’t have exact data on how many residents are trans, out of 842 participants in an LGBTQ+ community survey released by the county government in October 2023, 30.6% said they identified as transgender, nonbinary or gender expansive, and 7.4% said they were questioning or “not sure” about their gender identity.
“I’m excited about this report,” said Lee Blinder, who is the founder and director of Trans Maryland. “This is Montgomery County’s opportunity to really show out for the LGBTQIA+ community and specifically the transgender community this year.”
Trans Maryland advocates for the trans community and helps connect trans Marylanders with resources, from health care to legal assistance in name changes. Blinder created the organization in 2018 following their own difficulty in finding gender-affirming care in Montgomery County.
In interviews over the course of 2023, multiple trans county residents and advocates told MoCo360 that it was incredibly difficult to access gender-affirming care within the county. Several residents reported traveling to Washington, D.C., or Howard County to access appropriate care.
County data confirmed this: the survey released in October revealed that more than 41% of trans and gender expansive county residents faced difficulty finding gender-affirming care and gender-affirming mental health support.
One in six of trans and gender expansive respondents to the survey reported that a medical professional refused to provide them with gender-affirming care. More than a quarter of respondents said they had to “teach their provider about their sexual orientation or gender identity to receive appropriate care,” according to the survey.
In a March 2023 report, the United States Department of Health and Human Services defined gender-affirming care as “a highly specialized model of care that uses evidence-based practices to address distress arising from gender dysphoria.”
This care can vary based on the individual, but may include hormone replacement therapy, surgery and alterations to various parts of the body, voice therapy and other health care intended to help align a person’s body with their gender identity.
The OLO report identified three clinics within the county that offer limited gender affirming-care access, but no medical office that focuses on or specializes in it. The Planned Parenthood clinic in Gaithersburg offers hormone replacement therapy, Mary’s Center in Silver Spring has two clinicians who can provide hormone replacement therapy, and CCI Health Services, which has locations in Rockville, Silver Spring, Wheaton, Takoma Park and Gaithersburg offers “limited gender-affirming services.”
Trans residents and medical professionals who spoke to MoCo360 in 2023 shared that clinics such as Planned Parenthood often have long waitlists for appointments and follow-ups for refills on hormones, which lead to lapses in treatment and potentially dangerous side effects.
“Nationally and locally, the biggest barrier to healthcare for transgender individuals is a lack of knowledge and training among healthcare providers to respectfully interact with and care for transgender patients,” the report says. “As a result, many individuals report having to travel great distances to see knowledgeable providers, or they must be knowledgeable about their transgender healthcare in order to teach their provider about their own healthcare.”
While the report primarily addresses gender-affirming care, it also notes the difficulty trans residents face in accessing primary health care and other medical services unrelated to their gender identity. The report identified non-affirming environments and lack of health insurance as additional barriers trans residents may face in accessing appropriate care.
The report also noted that trans people face additional socioeconomic barriers to health care, including “living below the poverty line, higher rates of homelessness, higher likelihood of experiencing sexual and physical assaults, bullying, harassment and unequal treatment in public accommodations, and higher unemployment rates.”
The report specifically recommends that the council address the feasibility of creating a LGBTQ+ community center in the county, which could provide resources to residents including health care services, mental health services, support groups, meeting and recreation spaces, youth-specific services, legal services, employment support, housing services and more.
While there are similar centers that cater to the LGBTQ+ community in the District, Baltimore and Frederick, there is not a physical space like this in Montgomery County.
Local organizations such as the MoCo Pride Center and Live In Your Truth host LGBTQ+ events in the county, such as the annual Pride in the Plaza festival in downtown Silver Spring, but do not have physical spaces or provide health and wellness related services.
A common theme in responses to the county’s 2023 LGBTQ+ survey was the desire for an LGBTQ+ center or space.
“Having a gathering space with access to resources and shared conversation and community is so essential,” Blinder said. “The lack of that kind of space leads to health disparities and other disparities in access to resources.”
Amid “tough” budget constraints, Stewart said when it comes to funding a community space—or multiple spaces throughout the county—a possibility is for the council to look at sources of one-time funding to address the initial startup costs.
The other recommendation—to consider requiring LGBTQ+ competency trainings for medical providers to receive and retain licensure in the state of Maryland—can’t be accomplished by the council alone. It would have to be taken up as legislation in the Maryland General Assembly. But Stewart said there are some things the county can focus on.
“One of the things that I found really disturbing in the community survey was the high percentage of people who identify who are trans who said that they’ve been misgendered by a health care professional, or that they haven’t sought care in the last year because of a fear that they will be treated poorly,” Stewart said.
She said one way to address this is by taking up the sub-recommendation in the report for the County Executive’s office to create a comprehensive list of affirming health care providers, and for the county to look into ways it can support existing clinics such as CCI Health that are working to expand their offerings for trans patients.
Blinder said they support the recommendation, citing difficulties trans residents face when seeking health care of any kind, and how trans people often have to educate providers on their needs.
“Much of gender-affirming care is just basic health care,” Blinder said. “Basic understanding of our community and the basics of gender-affirming care should be at the heart of what it should takes to become a provider in the state, and we found that that’s not occurring there right now.”
Blinder said it’s important for the county to heed the recommendations as more LGBTQ+ individuals and families move to Montgomery County because of Maryland’s growing number of laws that protect LGBTQ+ people, including the Trans Health Equity Act, which was sponsored by Montgomery County-based Del. Anne Kaiser (D-Dist. 14) last year.
Blinder was appointed by Gov. Wes Moore (D) to the Maryland Commission on LGBTQIA+ Affairs, which advises lawmakers on issues affecting the community.
“Right now, there are people who are dedicating their personal resources to taking care of the community. We have really dedicated folks who are really putting in hours to provide resources to a young person who loses their housing after coming out, for example,” Blinder said. “We can’t be dependent on that. Folks moving here need to have resources and we are in a position to offer that.”