On Tuesday, June 11, the San Francisco California Board of Supervisors voted unanimously to make their city a place for everyone to safely access gender-affirming healthcare. The move makes San Francisco the largest self-declared sanctuary city in the US for transgender people.

The ruling applies to all gender non-conforming people including those who are transgender, non-binary, and Two Spirit – a term used to describe Indigenous and Native people with both a masculine and feminine spirit. Furthermore, city officials will be barred from assisting in any out-of-state investigations regarding people who obtain, provide, or help others access gender-affirming care.

San Francisco Board of Supervisors leader Rafael Mandelman said: “Our city has been and will continue to be a sanctuary and a beacon for our transgender and gender non-conforming siblings.” 

As other states choose to legislate hate, we choose to legislate love. This week the Board of Supervisors unanimously approved my resolution declaring San Francisco a sanctuary city for our trans and gender-nonconforming siblings. https://t.co/uTMXxKknw6

— Rafael Mandelman (@RafaelMandelman) June 14, 2024

In 2022, California became a sanctuary state for gender-affirming care when Governor Gavin Newsom signed a law agreeing not to release the personal information of any out-of-state residents seeking care in California, even if another state issues court orders for their arrest.

Since then, San Francisco’s director of the Office of Transgender Initiatives, Honey Mahogany, explained: “We have seen an influx of refugees, not just from other countries, but from other states who are seeking care and seeking sanctuary.”

San Francisco’s new law adds to the state’s existing legislation by ensuring that the city’s resources are not used to help law enforcement from other states prosecute healthcare providers or the families of minors receiving gender-affirming care.

As home to one of the country’s first LGBTQ+ neighbourhoods in the 1960s, San Francisco has a long history of protecting the transgender community and upholding their rights.

In 2017, three Black trans women founded Compton’s Transgender Cultural District which honours a coalition of trans women who used civil resistance to fight against discriminatory law enforcement in 1966.

June 24 2016, Gene Compton’s Cafeteria Way was unveiled as the new name for 100 blocks of Taylor Street, and in 2017 San Francisco recognised the Compton’s Transgender Cultural District after the tireless work of Janetta Johnson, Honey Mahogany, and Aria Sa’id. pic.twitter.com/OO8iKs8bi1

— MATE – Mutual Aid Trans Edinburgh ON HIATUS (@mate_edinburgh) February 20, 2021

Several cities in 15 US states have recently become safe havens for transgender youth and have laws protecting minors’ access to care. However, in contrast, dozens of US states are also currently considering anti-LGBTQ+ legislation that limits access to gender-affirming care.

In recent months, lawmakers in Tennessee passed a bill criminalising adults who help transgender youth access gender-affirming healthcare, and six states including Alabama, Florida, Idaho, North Dakota, Oklahoma and South Carolina have made it a felony for healthcare practitioners to provide such care to minors.

24 states have banned gender-affirming treatment, and according to the Trans Legislation Tracker, nearly 600 anti-trans bills have been considered in 2024. Even so, activists continue to fight back, and on June 11, Florida’s ban on gender-affirming care was permanently blocked in a federal court.