Background:
In Mexico, transgender people experience significant barriers to sexual healthcare and gender-affirming healthcare, including high levels of stigma, healthcare discrimination, and limited availability of doctors trained in providing gender-affirming care. A 2021 study found that 80% of transgender women have used feminizing hormones at some point, yet 65% self-medicate without medical supervision and important barriers include discrimination and poor treatment when accessing care, and difficulty finding doctors to provide hormone therapy.[1] These factors underscore the urgent need for accessible, quality healthcare and comprehensive provider training in gender-affirming practices.

Objectives:
To expand access to evidence-based and high-quality gender-affirming hormone therapy (GAHT) for transgender individuals in Mexico, through targeted medical education, clinical service expansion, and community empowerment via mentorship, leadership training, and direct community action.

Project Outline & Outcomes:

Between 2022 and 2025, the project has advanced the following initiatives:

• Secured funding through multiple grants totaling approximately $100,000 USD.

• Organized Mexico's first transgender health medical conference (April 2023) to educate local providers on best practices in GAHT and transgender healthcare. Over 800 registrants benefited from coursework both online and in-person over the course of a three day conference with an ongoing active online transgender health chat server of 230 individuals.

• Opened a limited-operations clinic offering direct access to GAHT, HIV and STI screenings, and HIV prevention therapies (PrEP/PEP). Provided funding for the ImpulsoTrans medical director to attend advanced training in Spain in February, 2025.

• Developed a curriculum aimed at training transgender community leaders to provide peer support, sexual health education, and referrals.

• Presented this work in a 75 minute symposium at an international conference during the biennial World Professional Association for Transgender Health International Scientific Symposium in Lisbon, Portugal in September, 2024.

• Create a training partnership that aims to provide expertise and mentorship from Spanish speaking professionals specializing in gender-affirming care from leading institutions in Mexico and the United States. This ProjectECHO will aim to provide training and longitudinal support and mentorship from experts in the field.[2]

Next Steps:

The objective of increasing access to GAHT through medical education and mentorship culminates in the development of a Spanish language curriculum and a team of experts from UCLA who provide both didactics and clinical mentorship to physicians interested in providing care to trangender individuals in Mexico. This will occur after ProjectECHO (Extension for Community Healthcare Outcomes), a collaborative, tele-mentoring model designed to democratize specialized medical knowledge.

Impact/Effectiveness:
Outcomes of the next phase of work with the launching of ProjectECHO will be monitored using the iECHO platform and reported in 2026.[3] The project will result in substantial improvements in healthcare access, including the direct provision of GAHT to underserved individuals and expanded HIV prevention services to reach rural communities.

Summary:
Community-driven healthcare initiatives effectively increase access and quality of transgender healthcare. Future efforts should emphasize scaling and replicating this model, advocating for policy changes to reduce barriers to care, and continuing to strengthen local capacity through ongoing provider training and community empowerment.

References:

1. H. Vermandere, A. Martínez Dávalos, D. Cerecero García et al., Encuesta Sobre Salud Sexual. Encuesta Sobre Salud Sexual de Mujeres Trans en México 2021: Resultados Principales. Instituto Nacional de Salud Pública, 2021.

2. Project ECHO. Project ECHO: Extension for Community Healthcare Outcomes. University of New Mexico Health Sciences Center. Accessed April 21, 2025. https://projectecho.unm.edu/​

3. iECHO. iECHO: Project ECHO’s Virtual Collaboration Platform. Accessed April 21, 2025. https://iecho.org/

Keywords: Gender-affirming care, Gender-affirming Hormone Therapy (GAHT), transgender health, HIV prevention