and more of them were seeking care. Medical coverage was improving under the Affordable Care Act, queer identities were more widely accepted and anti-discrimination rules put into effect by the Obama administration had recently pushed a handful of states, including New York, California, Colorado and Illinois, to make “medically necessary” mastectomies available to trans men. Rivera lived in a progressive city, had good insurance from his public-sector job, and was seeking care at a clinic named after two LGBT pioneers.


Rivera felt welcomed when he arrived for his first appointment at Callen-Lorde, in the fall of 2015. Stickers and sharpies for notating one’s gender preference were on offer at the front desk; ads for patient support groups played on a flat-screen TV. He wanted to start hormone treatment butare already uncomfortable now will feel they have license to discriminate outright, and will allow people to be shamed and refused,” says Flor Bermudez, legal director at Transgender Law Center.

In less populous areas, trans people—but also people with HIV, gays, lesbians and straight unmarried couples—may be left without medical options, Bermudez says. Teo Drake, a lapsed Catholic and trans man with HIV in rural Massachusetts, told me about an incident from 2015. After having genital surgery out of state, he noticed that a scar was failing to heal, and rushed to Baystate Medical Center, the hospital nearest to his home. When the doctor on duty refused to make eye contact or properly examine his incision, Drake had to drive to another emergency room almost an hour away. (Representatives