Aspen Ruhlin had the same primary care provider for eight years and never came out to them as transgender.<\/p>\n
Ruhlin, of Bangor, who uses they\/them pronouns, said they didn\u2019t have a chance to indicate their pronouns on a patient intake form. Later, when Ruhlin started treatment for cancer, they were \u201cnot able to feel comfortable or safe disclosing my identity.\u201d<\/p>\n
\u201cI was put in a position where I felt obligated to be closeted,\u201d Ruhlin said.<\/p>\n
Ruhlin\u2019s experience is not out of the ordinary. LGBTQ+ patients in northern Maine say it is often difficult to find a primary care physician they are comfortable with, and now the problem is getting worse.<\/p>\n
Maine Family Planning, whose three Aroostook County clinics are, according to experts, the only openly trans-friendly providers in northern Maine, stopped offering primary care in October, leaving more than 150 transgender patients scrambling to find another provider they can trust with their identities and health.<\/p>\n
\u201cThat has really hit my trans patients very hard,\u201d said Christina Theriault, a nurse practitioner at Maine Family Planning\u2019s clinics in Fort Kent and Presque Isle. \u201cAnd I don\u2019t have a good suggestion for them, to say: \u2018Oh, I know these people are trans-friendly. You can go there.\u2019\u201d<\/p>\n
Trans-friendly health care caters to the needs of transgender patients in a safe environment. Providers ask patients their preferred pronouns, are familiar with gender identity terminology and can accurately interpret lab values for people undergoing gender-affirming hormone replacement therapy.<\/p>\n
Theriault said there are now zero primary care clinics in Aroostook County that she can describe as \u201cdefinitely LGBTQ-friendly.\u201d Without that care, she says, more patients in the county will stay closeted and mask health concerns that could give rise to bigger problems down the road.<\/p>\n
\u2018Very private\u2019<\/p>\n
Maine Family Planning operates 18 clinics across the state. The organization has not been able to bill Medicaid since this summer<\/a>, when a provision in the One Big Beautiful Bill law passed in July restricted funds for reproductive health organizations that perform abortions. Officials said they cut primary care to preserve access to specialized health services.<\/p>\n More than half of all visits to the Presque Isle and Houlton clinics were primary care appointments. Now, former patients must navigate a rural primary care network that is already burdened by financial struggles.<\/p>\n Ten\u00a0years ago, Theriault sent a survey to other primary care clinics in the county, asking whether Maine Family Planning could include them on a list of trans-friendly providers<\/a>. None responded.<\/p>\n Some providers have told her there are no transgender people in Aroostook County, a sprawling, tree-covered area that is home to just 5% of Maine residents, according to recent census data. But of Maine Family Planning\u2019s\u00a0910 patients who receive gender-affirming care, nearly 20% live in Aroostook County.<\/p>\n Maine Family Planning is Aroostook County\u2019s only provider of hormone replacement therapy, or HRT, a medical treatment that supplements the body with hormones and can help align a person\u2019s physical traits with their gender identity. Theriault manages hormones for 159 patients between Fort Kent and Presque Isle.<\/p>\n \u201cI can manage all their hormones, but I am not primary care,\u201d Theriault said. \u201cIt needs to be somebody who is familiar with gender-affirming hormone therapy and understands what will need to be monitored.\u201d<\/p>\n A primary care provider might flag a patient\u2019s blood work as abnormal if they are only looking at hormone reference ranges for the patient\u2019s assigned gender, not their affirmed gender on hormone therapy, Theriault said. That provider could also miss worrying side effects: high cholesterol levels for patients on estrogen, or increased red blood cell count for those on testosterone.<\/p>\n The same goes for intersex people, who don\u2019t fit into the biological binary of male or female. Jovi, a 23-year-old student who lives part-time in Presque Isle who didn\u2019t want her full name used to protect her privacy, drives down to her family doctor in southern Maine for intersex hormone therapy.<\/p>\n In northern Maine, people stare when she wears black lipstick, said Jovi. Health care providers have never mentioned the intersex marker on her chart.<\/p>\n \u201cI don\u2019t think it\u2019s necessarily that care providers would deny that care,\u201d she said. \u201cI just know that the culture up there all around is very private.\u201d<\/p>\n Discrimination in health care<\/p>\n While hormone replacement therapy is commonly associated with transgender people, most recipients are cisgender. A woman who receives HRT to manage menopause symptoms is no different than someone who is transitioning, Ruhlin said.<\/p>\n Ruhlin now works in community engagement at Mabel Wadsworth Center, a feminist sexual and reproductive health practice in Bangor and the northernmost HRT provider in Maine outside of Theriault. The practice sees 600 patients for gender-affirming care \u2014 a total that has gone up each year, Ruhlin says.<\/p>\n There are 2.8 million people 13 years and older in the United States who identify as transgender<\/a>, according to the Williams Institute, a think tank at the University of California.<\/p>\n