a day ago
- Health
- San Francisco Chronicle
He took over a trans health nonprofit in California. Trump and Newsom made his job harder
SACRAMENTO — There is a room inside the Gender Health Center where the dead kick it with the living.
It's in the back, on the two-story building's first floor, in a high-ceilinged common area that holds harm-reduction offices, racks of donated clothes, a curtained fitting area and cubbies stocked with free makeup, bra inserts, tucking underwear and skin-color swatches. Against a wall facing some well-worn couches is the altar, where about 30 people who have died, including the center's founder, are memorialized in pictures, words, paper flowers, flags and unlit candles.
'It's continuing to include our family who has transitioned (into death) in our celebrations, in our joy-centered work,' executive director Malakai Coté explained as his staff chatted and chuckled around a plastic table several yards away. 'To me, it's a celebration space. It's a lament, but it's also a celebration.'
Not many things are just one thing to Coté, the 43-year-old therapist who somewhat reluctantly accepted the top job at the gender-affirming health provider in March 2024, eight months before Donald Trump reclaimed the White House with a campaign that vilified transgender people and immigrants.
Less than five months into his second term as president, Trump has issued directives to strip transgender Americans of their health care, revoke housing and employment protections, ban them from military service and women's sports, and erase them from federal documents while penalizing the states that don't go along.
Coté and his organization, which is emerging from a period of internal turmoil, are also contending with the prospect of debilitating state funding cuts as they swim against a national political backlash marshaled by a president who maintains that trans people simply do not exist.
And yet.
On a warm weekday afternoon at the beginning of Pride Month, the vibe inside the Gender Health Center was relaxed and happy, Coté's mood inviting and confident.
He greeted a mother and adolescent child in the small lobby colorfully cluttered with wall art, queer media, encouraging sticky notes and a binder full of letters from past clients to new ones, letters that Coté still chokes up reading aloud. He showed off the cozy therapy wing, a lounge-y electrology studio, rooms and nooks where clients get blood panels done, pick up hormone kits and meet with a bubbly personal stylist, all for little to no money. He described an almost secret power — Coté called it 'magic' — within marginalized groups to create community in harsh conditions.
Borrowing his mental health director's analogy, he compared it with composting, taking something discarded and — through the right amount of heat and movement — turning it into something that can grow new life.
'There's something that queer and trans people have figured out because we've had to. Because no one else was there,' he said. Thinking of the psychologically bruising politics and worsening national attitude, he added, 'There's also a responsibility to share that.'
Journeys
Coté came to the Gender Health Center around 2012, as a client. He was finishing up his master's degree in family therapy through the University of Oregon and eager to begin his medical transition.
He paid out of pocket for several one-and-done consultations with primary care physicians but, not wanting to be someone's first trans patient, kept looking. One of the doctors referred him to the center, where a graduate student helped him get his paperwork to start hormone therapy. Facing a monthslong wait in Sacramento, Coté was able to fast-track the process by working with a nurse practitioner at the established Lyon Martin Community Health Services in San Francisco.
But Sacramento was his home. And the scrappy, low-budget Gender Health Center had promise.
Psychology student Danelle Saldana started the center in 2008 with $650 that she spent on incorporation fees, a telephone line and a post office box — alongside four volunteers who included her mother — tax records show. Saldana was moved and inspired by the people she met through her internship at the Sacramento LGBT Community Center, said her mother, retired social worker Essie Saldana.
'She just worked tirelessly to put the foundation together,' Essie Saldana said.
Danelle Saldana died in her sleep in January 2009. She was 30.
The Gender Health Center opened the next year.
It has never been a flush operation. Its 2023 revenue intake of $703,000 marked the lowest since 2015, a period that overlapped with the center churning through six executive directors in three years, none of whom earned more than $69,500 annually and most of whom made considerably less.
'It had its ups and downs,' said Essie Saldana, who sits on the board. 'We all come with our own brokenness and our own issues, and sometimes it doesn't always work out that you can keep those things outside of your workplace. So we did. We had some significant turnovers.'
In 2022, two co-directors resigned amid accusations of financial mismanagement, which prompted a strike and crowdfunding campaign for five fired staffers. They were followed by an interim director and several months where the board ran the organization.
Coté, who was in private practice and consulting the center on its mental health programming, heard rumblings that funders were getting nervous about the nonprofit's direction. He had turned down a leadership position before. But he also kept hearing from people in his everyday life how important the Gender Health Center had been to their journeys. It was important to his. And he saw it moving in a positive direction.
'So then I got asked again,' he recalled. 'I said, 'OK.''
Ebony Harper, who started her advocacy career at the Gender Health Center in 2016 and now co-chairs Lt. Gov. Eleni Kounalakis' Transgender Advisory Council, praised Coté as 'one of the most grounded and visionary leaders I've worked alongside.'
'He's stepping into this role during a time of intense political pressure, statewide budget cuts, and escalating attacks on trans communities,' Harper said in a text message. 'And he's doing it with clarity, tenderness, and this powerful sense of responsibility to both healing and justice.'
Coté said the Trump effect has manifested most noticeably in a dour pall. Parents are worried about their children's access to treatment and rushing the waitlist. Employees and clients are concerned the president's dehumanizing rhetoric will encourage anti-trans violence in the same way hate crimes soared against the Asian American and Pacific Islander communities after Trump scapegoated China for COVID-19.
The national LGBTQ advocacy nonprofit GLAAD said it tracked more than 930 anti-LGBTQ incidents in the country over a 12-month period ending on May 1, a 14% increase from the previous year and with more than half of the incidents perpetrated against trans people.
'Act of erasure'
A different threat manifested from California Gov. Gavin Newsom, who divided his own party when he criticized trans athletes on his podcast with conservative influencer Charlie Kirk.
Contending with a $12 billion state budget shortfall partly owing to Trump's tariff decisions, Newsom eliminated $31 million in LGBTQ funding in a budget proposal known as the May revision. The money accounts for three-tenths of a percent of the state's projected deficit, and a lot more to the 68 community organizations that were expecting it.
'These aren't just cuts — they're an act of erasure,' Bamby Salcedo, president and CEO of the TransLatin@ Coalition in Los Angeles, said in a statement responding to Newsom's budget. 'The state is pulling funding from programs that were already promised, already contracted, and already making an impact in our communities.'
Coté said the Gender Health Center stands to lose $500,000 — almost half of its funding — imperiling a core mental health program serving nearly 200 clients with 80 more wait-listed. Coté joined a coalition of LGBTQ, immigrant and reproductive health advocates lobbying against the cuts.
The Legislature approved a $325 billion budget Friday that restored the threatened programs and rejected other Newsom cuts, but continued a freeze on new Medi-Cal enrollments for undocumented adults. State lawmakers and Newsom have until July 1 to ink a final budget deal.
If the Bay Area and Southern California have more established support infrastructures for trans, nonbinary and gender-expansive residents, Sacramento's Gender Health Center occupies more rarefied air.
According to the member-based coalition CenterLink, there are 60 LGBTQ community centers in California and 375 in the U.S., an unofficial tally that doesn't include the Gender Health Center. Mind the Gap, a consortium of gender care providers associated with the UCSF Child and Adolescent Gender Center, shows nine gender-affirmative organizations in the Bay Area.
By all appearances, the Gender Health Center seems to be one of the few trans-led nonprofits offering its blend of free health and cultural services north of the Bay Area.
In January, it opened an electrology studio to instant and overflowing demand.
Arely Aguayo, owner of eleQTrospot, said they stumbled onto the untapped market potential while studying at the Monterey Bay Institute of Electrology, where their instructor and classmates dismissed their idea for a gender-affirming studio that bills insurance providers. Aguayo, a former health care advocate, understood the hesitancy. Their spouse and business partner spends hours each day calling and emailing insurance providers and, when that doesn't work, bringing in legal aid workers.
'She's freaking awesome,' Aguayo said. 'To this day, we still have people (asking), when are you gonna be open? … I just hope it opens doors for other electrologists to start accepting health insurance.'
Coté is working on that piece now, through budding partnerships to train electrolysis providers in Butte County and mental health providers in Yuba County. He said he was also in the process of diversifying the center's funding to be less dependent on the state, but Newsom's cuts moved up the timeline by more than a year. Coté said the Gender Health Center was one of roughly four organizations like it to receive money through the California Reducing Disparities Project, which Newsom proposed cutting.
Essie Saldana says she'll give what she can.
'I don't have any grandkids. She was my only daughter. So everything I had would've been hers,' she said, her voice breaking. 'So it goes to the Gender Health Center.'
The retired social worker spent nearly 50 years working with physically and developmentally disabled children. She sometimes took her daughter to work when Danelle was a toddler, and said she had to be told not to help the other kids so much, that they needed to learn to fall and get up on their own.
'But that was my baby girl,' she said.
Coté sees himself as an inheritor in more ways than one. He took the job out of a sense of duty and will remain in it as long as he feels he's continuing the work of his predecessors and benefiting those around him. His hope is that he's cultivating his own replacement. He thinks of the dead and gone, what they endured, yes, but also what they enjoyed and imparted.
His great-great-grandfather was enslaved. His grandfather was a taxi driver who used his hack and wage to bring food to his church, that generation's version of a social safety net. Coté has a doctorate and a platform.
'This is how I think about gender anyway,' he said. 'It's more about seeing possibilities. Oh, this is a possibility that's within me, and now I'm embodying it. And with any possibility, there's hope.'
