The Woods All Black by Lee Mandelo

The Woods All Black is equal parts historical horror, trans romance, and blood-soaked revenge, all set in 1920s Appalachia

Leslie Bruin is assigned to the backwoods township of Spar Creek by the Frontier Nursing Service, under its usual mandate: vaccinate the flock, birth babies, and weather the judgements of churchy locals who look at him and see a failed woman. Forged in the fires of the Western Front and reborn in the cafes of Paris, Leslie believes he can handle whatever is thrown at him—but Spar Creek holds a darkness beyond his nightmares.
Something ugly festers within the local congregation, and its malice has focused on a young person they insist is an unruly tomboy who must be brought to heel. Violence is bubbling when Leslie arrives, ready to spill over, and he’ll have to act fast if he intends to be of use. But the hills enfolding Spar Creek have a mind of their own, and the woods are haunted in ways Leslie does not understand.

The Woods All Black is a story of passion, prejudice, and power — an Appalachian period piece that explores reproductive justice and bodily autonomy, the terrors of small-town religiosity, and the necessity of fighting tooth and claw to live as who you truly are.