This article was produced as a project for the USC Annenberg Center for Health Journalism’s 2026 National Fellowship Dennis A. Hunt Fund for Health Journalism. It’s part of a series on LGBTQ+ health in rural areas.
Some of the names in this story have been altered for privacy reasons.
When Christine first decided to go on hormone replacement therapy, she opted for Planned Parenthood, what she called “the path of least resistance”: providers with the knowledge and resources to get her started on that part of her transition. But from where she lives in South Lake Tahoe, the closest Planned Parenthood locations are hours away. So she swapped to a provider at Barton Hospital—the single major hospital serving the south shore.
“My primary care provider told me she had never done it before,” said Christine. “I was the one doing hours of research online and talking to friends and networks to find out what she should prescribe me.”
Christine wasn’t alone. To understand these trends in the Lake Tahoe region, the Tribune surveyed 15 LGBTQ+ people and interviewed over a dozen patients, policy, and health experts.
Other LGBTQ+ people seeking gender-affirming healthcare, STI testing or mental healthcare told the Tribune that they didn’t trust that their providers knew enough to deliver the healthcare they deserved. Many said they actively educated providers on what they needed.
The Tribune agreed to grant anonymity to some people interviewed for this story because of safety concerns stemming from harassment, stalking, threats or violence after participating in public discourse.
Across the nation, rural residents are underserved in healthcare, with poorer health outcomes than urban counterparts, healthcare worker shortages and farther distances to travel among other challenges.
LGBTQ+ people in rural communities face additional barriers that can lead to substandard care or traveling even farther than neighbors.
Research from the Rural Health Research Center at the University of Minnesota showed that the top two challenges for rural LGBTQ+ populations was a lack of resources and lack of cultural competency.
Christine said she struggled to find local providers, let alone ones who could understand her life and needs as a transgender woman. And while searching online came up with more results, she said she both wanted and needed in-person care to feel like her health was being taken seriously.
“It’s really unfortunate that in a city of 20,000 people, the handful of trans people I personally know just can’t get the care we need here,” said Christine. “My provider was willing to do what I asked, but I would prefer someone who actually had the experience and knowledge.”
Finding LGBTQ+ providers in rural areas
Finding providers in rural areas is hard enough—finding ones who are LGBTQ+ friendly is another challenge entirely.
Rural gay, lesbian and bisexual populations already self-report worse health compared to urban and heterosexual populations, and have higher rates of chronic conditions compared to their urban LGBTQ+ counterparts. In general, rural residents worry about how they’re perceived in smaller communities, but for LGBTQ+ populations, it makes it even more intimidating to come out or discuss LGBTQ+ related issues with providers.
Morgan Williams, a psychiatric emergency services therapist working in the Tahoe area, said, “While there is a certain resiliency to rural communities, there can also be a stigma around care.”
Fewer providers also means there’s a risk that patients will get stuck with someone that is at best, uninformed and at worst, actively hostile. And they have to deal with substandard care until another provider opens their availability.
50% of respondents surveyed by the Tribune say they couldn’t find quality local healthcare, and over 60% seek LGBTQ+ healthcare outside the area.
David Mack, a gay man living in Truckee and founder of Truckee Pride, said high turnover rates at the Tahoe Forest Health System, also called TFHS, means he has had to navigate disclosure again and again. He’s currently on his third provider.
When trying to find another provider at TFHS, Mack said that he was essentially just given a list of names. “There was nothing to go on, no provided information about if they were friendly to queer people or not.”
Sam Grossberg, a resident of Truckee who also identifies as gay, said that compared to San Francisco, the doctors in Truckee and Tahoe lacked awareness, knowledge and cultural sensitivity. His primary doctor is in San Francisco, who he typically sees through telehealth because he trusts him more with diagnoses, treatment and prevention. “I didn’t feel I was going to be able to get that kind of care from a Truckee primary care doctor who wasn’t part of the LGBTQ+ community or had any sort of specific training.”
Respondents throughout the Tahoe Basin felt similarly, saying they didn’t feel that doctors would take their concerns seriously, understand their needs or were attuned to the realities of LGBTQ+ people.
Newly out members suffer
Often, LGBTQ+ people hide their identity or stay “in the closet” out of fear around their safety. In a time when LGBTQ+ people are facing increased discrimination, being “out” can lead to harassment, threats and an overall lower quality of life. The Tribune’s survey received several fake, hateful responses and harassment for reporting on LGBTQ+ health.
A KFF report from 2024 showed that LGBTQ+ adults are twice as likely as cis, straight adults to report negative experiences while receiving healthcare. That included providers treating them unfairly or with disrespect, assuming something without asking, suggesting they were personally to blame for a health problem, ignoring direct requests and questions or refusing to prescribe needed pain medications.
Christine helped shape policy at Barton’s labs to stop calling out patients’ old names on the chart, which often lead to “deadnaming” trans patients who had not yet legally changed their name. Instead, the labs now regularly use the buzzers system that was already in place.
While Christine has generally had positive experiences there after she reported the deadnaming issue, she said that once when she corrected a technician on her name, the tech was rude, dismissive and intentionally hurt her during the blood draw by putting unnecessary pressure on the needle.
Many of those that the Tribune interviewed have been out for at least two years, if not many more. Almost all of them worried about how challenging it is for newly out people and LGBTQ+ youth receiving treatment.
Some reported that even when just looking for information about LGBTQ+ topics, they tended to trust their own research over providers who seemed to be unaware of concerns like cancer rates, the range of hormone treatments, worries around substance abuse and more.
“Early transition or even just coming out is such a time of instability, it’s hard to find care because you fear rocking the boat,” said Williams. “When there’s no one to answer questions for people in those early stages, it can make it that much harder.”
Not being able to answer questions that people may have about their health makes them less likely to trust providers. And historically, the LGBTQ+ community has been fearful of medical care: from being outright ignored, especially during the height of the HIV/AIDS pandemic, pathologized through diagnoses, or being gaslit more frequently in medical spaces, there’s reason to feel nervous.
Perceived hostility can dissuade patients from pursuing any sort of care. Others said they hide parts of themselves from physicians to avoid mistreatment.
“I was worried about judgment or being misgendered at Barton,” said Anthony Wolf, who typically goes by their legal name in professional spaces. “I feel like it’s a protective measure to use my legal name rather than my chosen name, because then I never give them the opportunity to leverage my gender or expression against me.”
Wolf continued, “If I never had to hear a story of someone getting deadnamed while getting treated, that would make me a lot more comfortable.”
Education for providers
A 2018 study of rural primary care provider experiences and knowledge on LGBTQ+ health showed that while 89% of respondents believed knowing a patient identified as LGBTQ+ was important to providing optimal primary care services, only half of them had received education specific to LGBTQ health concerns.
Jasen Brooks, director of identity and cultural engagement and lecturer at the Orvis School of Nursing at the University of Nevada, Reno, spoke to the Tribune on how culturally competent healthcare creates more trust.
“Having responsive healthcare has been tied through research to better patient outcomes, better satisfaction from the interactions of healthcare providers to the patients and their loved ones, and better communication between the provider and the patient,” said Brooks. “That means diagnostics and education about health-related activities, and frankly, our patients being willing to listen to and follow the health advice that we give them increases when we have that rapport from a person-centered perspective and an understanding of their background and culture.”
Finding that education can be tricky though. Brooks said that it often comes down to the interests of individual healthcare providers’ interests and who they assume they are caring for.
Teaching providers
One respondent to the Tribune’s survey cited an incident in which, while getting a sexual health panel, their doctor in Truckee didn’t think to test for mpox, which became a heightened concern for gay men in recent years. They also noted that the medical assistant and receptionist used the outdated term “monkeypox”, which was changed to mpox in 2022 to reduce stigma—showing that it’s not just providers, but other staff involved in hospitals that may need education.
It’s not just cultural experiences that LGBTQ+ patients have to teach their providers about. It’s also medical knowledge. But Christine found it hard to find straightforward information to bring to her provider because “gender affirming care for transgender people is really understudied.”
She found recommendations often were outdated—formulations for hormones have changed from synthetic to bio-identical, meaning that some of the concerns around how medication is prescribed has changed significantly.
Because her provider was unsure about how to approach that care, Christine wondered if the research her doctor was seeing was outdated or if she would be able to understand the nuances of what she wanted out of her transition. While she said her doctor did her best and she was grateful, that doctor ultimately ended up leaving Barton, meaning she had to start the whole process again with a new one.
Mack, who has also gone through the turnover process, said, “You start from scratch with each new provider. I’ve provided research and resources about my health to each provider, but you have no idea how hard it might be to talk with providers about your life. You worry about them being conservative.”
Others said they had to discourage “trans broken arm syndrome”, a colloquial term that refers to medical discrimination where healthcare professionals relate their trans patients healthcare concerns to their gender identity, even when not applicable.
One trans respondent said that when they went to the emergency room at Barton for a kidney infection and UTI, their doctor assumed the UTI was linked to their transition, even though they had not had any medical work done that would have indicated that.
Respondents generally said there was a lack of understanding of the average health concerns around transition or sexuality when it came to the LGBTQ+ community.
Medications like PrEP or Doxy PEP are important to LGBTQ+ health, especially gay men, because they reduce the chances of HIV infection. PrEP, or pre-exposure prophylaxis, can be taken regularly and can be in pill or injection form.
Mack said he had to tell his provider about the different options, including clarifying that there were PrEP injections and that they were regularly used. That was unusual to him because injectable PrEP has been approved for use by the FDA since 2021. TFHS told the Tribune that they offer oral PrEP and are looking at offering injections, but have not yet implemented it.
What could change?
Community members overwhelmingly told the Tribune that they wanted more education and more resources for their local healthcare centers.
“I don’t want to go online or somewhere else for my care. I want my primary care provider, who knows me and sees me in person, who’s supposed to have all this information about me, to know how to provide care for me as an LGBTQ+ person,” said one respondent to the Tribune survey.
Barton Hospital’s chief medical officer, Dr. Kandra Yee, wrote in an email that there is an expectation that every patient receives respectful, equitable care, and the hospital has not received any formal grievances alleging inequitable care related to sexual orientation or gender identity from 2025-2026.
“Barton Health employees complete annual education that includes expectations for respectful, compassionate and culturally sensitive interactions with patients, including modules specific to the LGBTQ+ community,” wrote Yee. She said that physicians maintain their continuing education through their respective licensing boards and professional organizations.
“Our patient registration process allows individuals to identify both their sex assigned at birth, when clinically appropriate, as well as their preferred name and gender identity. Preferred names and gender identity are displayed prominently within the electronic medical record to help support respectful interactions throughout a patient’s care,” wrote Yee.
Yee did not provide answers on policy consistency on LGBTQ+ patients across departments or specific guidelines given to providers on how to handle LGBTQ+ patients beyond “considering individual anatomy and medical needs.”
The Tribune was also unable to speak with any providers at Barton Health on how they approach LGBTQ+ care.
Both Barton and Tahoe Forest Health System have nondiscrimination policies, though Tahoe Forest Health System also did not specify whether they had one specific to treatment of LGBTQ+ patients.
Tahoe Forest Health System wrote to the Tribune and said that along with inclusive data collection, privacy, documentation and inclusive language, they are required to provide cultural competency training to staff under Nevada Senate Bill 470. The bill highlights the importance of understanding and effectively serving diverse cultural, racial, religious, gender and LGBTQ+ backgrounds.
States often have requirements of healthcare facilities and providers to ensure they retain their licenses. California and Nevada, the two states that Lake Tahoe straddles, are required to provide LGBTQ+ care based on their state policies. And staying licensed as a medical professional in California and Nevada requires a certain number of continuing education units.
Brooks and others are pushing for those units to have a wider range of sources that are kept up to date.
University of Nevada, Reno (UNR) is also offering a rural health education program at their Lake Tahoe campus, which they hope will serve not just the Tahoe and Truckee areas, but extend into the rural areas of Gardnerville, Minden and Carson City in the foothills of the Sierra Nevada. The program aims to train health professionals with a deeper understanding of the rigor and the strengths of rural healthcare.
Other efforts, like Project ECHO Nevada offer continuing education to underserved communities, especially rural ones, along with networks of experts and peers who share their expertise.
Brooks, who leads the LGBTQ+ portion of continuing education curriculum development through a collaborative at UNR, says, “It’s really the healthcare provider’s responsibility to be prepared to manage any person. Every healthcare provider really should be focusing on some queer healthcare education, whether it’s required or not, because they’re taking care of individuals from the community.”
When more specialized care is needed, where do LGBTQ+ patients go? And what is the cost of rural healthcare travel? Read more in part two of this reporting project on LGBTQ+ health in Tahoe, scheduled to publish in next week’s edition of the Tahoe Daily Tribune.
