“We Don’t Get to Go Just Anywhere” Community Health Assessment of Barriers to Gender-Affirming Healthcare in Fresno, California ^†

Research on access to healthcare for transgender populations in California remains mostly focused on the major city centers, leaving out many rural and poorer areas of the state. Understanding the barriers to gender-affirming healthcare in a largely rural, agricultural, and low-income area is critical in creating effective policies and programs to address significant gaps in transgender healthcare. This is especially true in regions like Fresno County, which sits within the heart of the Central Valley of California, that are mostly rural and agricultural. This study conducted a community health assessment using a mixed-methods approach, focusing on transgender communities’ experience of accessing healthcare and gender-affirming healthcare in Fresno County and on the various existing barriers and critical needs. The study reveals the critical deficits in accessing gender-affirming healthcare in Fresno County, especially regarding doctors providing gender-affirming care, as well as the larger implications this has on the health and well-being of transgender individuals living in the Central Valley.