Update: June 2, 1:30 p.m. This story has been updated to reflect the date change of the workshop at the Rio Vista Community Center.
Andi Tiscareño knew she wanted to be a girl since she was six years old.
Tiscareño grew up the youngest of four siblings in El Paso’s Lower Valley. As a child she didn’t know terms like transgender and gender dysphoria existed. She tried to be like her older brother, her protector, and she played football to fit in with the other boys at school. But deep down, as she watched her older sisters putting on their makeup, she knew she identified as a girl.
“I don’t know how many nights I prayed I would just wake up as a girl,” Tiscareño said. “Most trans people wish they had been born the gender or sex they identified with. But things don’t work out that way.”
After graduating high school, she began attending a transgender support group that later became the Borderland Rainbow Center, an LGBTQ nonprofit where Tiscareño currently works as a youth services coordinator and administrative assistant.
Tiscareño now shares the organization’s resources at an event that brings together advocates of transgender health care.
The University of Texas at El Paso and Borderland Rainbow Center have partnered up on BLOOM, a series of workshops about gender-affirming care. The monthly event connects transgender and nonbinary people, as well as friends and family of the community, to health care providers and services available in El Paso.
Rebekah Harmann, who lives in Santa Teresa, New Mexico, attended the March workshop with her wife to support their transgender daughter. Harmann said an event like BLOOM would have been helpful years ago when their daughter, who’s now an adult, came out as female. At the time, their pediatrician couldn’t offer much guidance in how to navigate this transition, Harmann said.
“It’s very difficult to find information so to get all these resources in one place was really, really awesome,” Harmann said. “There are so many diverse establishments out there working with the trans community that just wow, I didn’t even know a lot of those things.”
Services in El Paso include voice modification, hormone therapy, and LGBTQ-oriented mental health care. The event also educates participants on public health disparities and the process of changing their name and gender on legal documents. Harmann worries about the impact Texas Senate Bill 14 will have on life-saving health care for transgender youths. The legislation bans transition-related medical treatment for people under 18 and now sits with Gov. Greg Abbott, who said he will sign the bill into law.
At a time when the LGBTQ community feels under attack, the BLOOM workshop isn’t just informational – it helps transgender and nonbinary people find others like them as well as advocates in their corner, Tiscareño said.
An estimated 93,000 adults and 30,000 youths identify as transgender in Texas, according to a 2022 report by the Williams Institute at the University of California at Los Angeles.
While transgender people make up less than 2% of the state population, they report a high rate of suicide attempts because of discrimination, harassment and rejection from family. Transgender people are also more likely than cisgender people to be victims of violent crime, a study from the Williams Institute shows.
Brandon Merritt, a speech-language pathologist and assistant professor at UTEP, started developing BLOOM in September 2022 after their department received a $7,000 grant from the university to “address gender minority health inequity in an underserved, predominantly Hispanic/Latinx community.”
Gender-affirming care encompasses a broad range of interventions, from vocal therapy to hormone blockers, to help someone whose identity doesn’t conform with their sex assigned at birth. Transgender people face obstacles when they seek gender-affirming care, such as their insurance provider not covering their treatment or their primary care doctor lacking knowledge about transgender needs, Merrit said.
“A lot of times providers are disrespectful when it comes to health care, so people just avoid going to the doctor,” Merritt said. “And the health care system and the legal system can be really confusing to navigate if you don’t have good health literacy.”
The BLOOM workshop series aims to target those challenges, they said.
Merritt’s research focuses on how people use the way they speak to communicate their gender. They work with students and professors from UTEP’s College of Health Sciences and School of Pharmacy to put the educational program together. The UTEP team and Borderland Rainbow Center host the workshop at a new location each month to reach the broader region, Merritt said.
The first workshop was held in March at Borderland Rainbow Center in Central El Paso, where about 15 participants rotated between different stations. At the entrance of the red brick building, people received information on LGBTQ-friendly health care providers and social services in El Paso and Las Cruces.
Inside, participants learned about public health disparities from social work students and what to expect in voice therapy. Clinical Associate Professor Patricia Lara and students in the speech-language pathology program at UTEP provide one of the few voice modification labs in the region.
In another room, participants played a “Jeopardy”-style game to test how much they knew about testosterone and estrogen therapy, while pharmaceutical students demonstrated how to safely self-inject hormones.
Many pharmacy schools have not incorporated LGBTQ health in a meaningful way, said Christopher Medlin, a pharmacist at University Medical Center and clinical associate professor at UTEP.
Medlin teaches his students to counsel their patients without making assumptions about their patient’s gender or what they use their prescriptions for. Someone picking up an estrogen patch could be managing their menopause, but they could also be transgender and going through hormone replacement, he gave as an example.
“I think equity transcends not just patient health care, but also the classroom,” Medlin said. “Pharmacists have been described as the most accessible health care workers. There’s a Walgreens pharmacy on every corner. We’re in a position to be the person who connects people to health care in general.”
Medlin also hopes to see more pharmacists practice in clinical settings in El Paso, such as hospitals and community health centers. He’s working with Dr. Toni Ramirez, a family medicine physician, to start a pharmacy at her clinic that serves the queer community.
Ramirez, who joined a BLOOM workshop recently, is among the few doctors in El Paso who provides gender-affirming care and hormone therapy to transgender adults. She practices at Centro San Vicente. The federally funded, nonprofit health center takes in patients regardless of insurance status, giving uninsured patients a sliding scale for payment.
People can see Ramirez at the clinic on Pebble Hills Boulevard, where her patients’ ages have ranged from 18 to the 60s. Along with hormone therapy, she coordinates referrals for patients seeking surgery, as well as mental health services with an on-site therapist. Therapy is not a requirement, however, to receive gender-affirming care, she said.
Ramirez grew up in Socorro and completed her medical residency at Santa Rosa Family Medicine in California, where she ran a health clinic for transgender adolescents. She moved back to El Paso during the pandemic after nine years of practice in gender-affirming care.
Many of her patients now are coming in with distress over SB14, she said. The bill bans transition-related medical care for transgender youths, but her adult patients worry the state will take away their medical care too in the future, she said.
Ramirez said the bill sends a public message that transgender people should not exist – and fears the policy will have fatal consequences. Her comments on SB14 reflect her opinion and do not represent a statement from Centro San Vicente, she said.
At one of the BLOOM workshop stations, Tiscareño shares resources available at Borderland Rainbow Center, such as therapy and group counseling, as well as social events for queer youths and allies. It’s important to provide a space that isn’t centered around drinking and bar culture so that people who are underage or recovering from substance abuse can feel welcome, she said.
She fears a slew of Texas legislation will harm LGBTQ people’s mental health. Tiscareño doesn’t know if she’d be alive today without the support of her family after she came out at 18.
“If I didn’t have the support or resources available now, I don’t think I would have made it past 20,” Tiscareño said. “There are a lot of folks who have died waiting for those resources, who didn’t have that support and acceptance, a lot of people especially kiddos who feel they would be better off dead.”