On Tuesday, the San Francisco Board of Supervisors officially declared the city a sanctuary for people claiming to be transgender, gender nonconforming, nonbinary, or Two-Spirit, abbreviated as TGNCI2S in the resolution. This makes San Francisco the largest United States city to adopt such a resolution in an apparent response to increasing state-level legislation aiming at protecting gender-confused minors from irreversible medical interventions. Sacramento and West Hollywood are two other United States cities that are “transgender sanctuaries.”

The resolution opens with a summary of the surge in legislation aimed at protecting children and women by limiting or prohibiting access to certain medical procedures and drugs and by excluding biological males from women’s sports and places such as public bathrooms across the United States:

WHEREAS, In 2024 alone, 515 pieces of legislation that target the LGBTQ+ community have been introduced across 40 states; and

WHEREAS, These bills aim to limit the rights of transgender, gender non-conforming, non-binary, and Two-Spirit (TGNCI2S) people by criminalizing gender affirming healthcare, restricting use of public bathrooms, forcing teachers to out their students, and preventing youth from participating in school activities…

The pronouncement continues by lamenting that “nearly half” of these legislative initiatives “specifically target transgender youth and their families.” As a result, four attorneys general, from the conservative states of Tennessee, Missouri, Indiana, and Texas, have opened investigations into hospitals performing “transgender” procedures on both minors and adults for alleged Medicaid fraud or violations of consumer protection laws. As a part of the investigations, the AGs have demanded access to patients’ medical records, which was condemned by the San Francisco supervisors and viewed as an infringement on “transgender rights.”

The supervisors further quote California’s legislative framework, which is extremely liberal in regard to the LGBTQ movement. In particular, in 2022, the Golden State passed Senate Bill No. 107, which, as quoted in the pronouncement, “protects individuals seeking sanctuary from out-of-state prosecution and explicitly prohibits law enforcement agencies from knowingly making or participating in the arrest or extradition of an individual pursuant to an out-of-state arrest warrant based on another state’s law against receiving gender affirming healthcare in California.” That law makes California one of 13 states, plus the District of Columbia, that have so-called shield laws protecting access to “sex-change” medical procedures.

This situation poses a significant legal challenge for non-California parents who oppose irreversible “trans” interventions for their children. If their child travels to California, he or she could potentially undergo “gender-affirming care” without the risk of extradition or legal interference from their home state. In other words, this scenario could allow minors to access treatments that their parents disapprove of, bypassing enforcement of their state laws. Critics argue that this legal shield undermines parental rights and state legislation aimed at regulating or limiting such medical procedures for minors, effectively allowing California’s more permissive stance on these procedures to supersede the legislative intentions of other states.

The proclamation quotes research from institutions such as Stanford and Yale Universities that reached the conclusion that “gender-affirming care” improves patients’ well-being, including better mental health outcomes and lower suicide risks. Notably, there are numerous other studies, including the most recent ones, that show that individuals who have undergone sex surgeries have an increased suicide risk. The study published in Cureus in April found that fully “transitioned” adults were 12.12 times more likely to attempt committing suicide than those who did not undergo such operations. Another study, using California’s own government data, found suicide rates significantly increased in those who underwent phalloplasty, and even more in those who underwent vaginoplasty.

In addition, the proclamation quotes favorable research on puberty blockers for minors. Omitted is the fact that puberty blockers, also known as gonadotropin-releasing hormone (GnRH) agonists, are linked to brain swelling and blindness in children, according to the U.S. Food and Drug Administration (FDA). They also can cause a host of irreversible adverse effects, such as infertility, bone density loss, adverse impact on brain development, and growth suppression.

While celebrating the proclamation, local LGBTQ advocates believe the city should be providing even more support to the community. According to the San Francisco Examiner, Eden Will, a spokesperson for the support and social group Transgender SF, said that “if San Francisco doesn’t include funding for safe housing or health care, then the resolution would fall short in protecting its intended communities.”

It is worth noting that the city already has been spending a considerable amount of resources providing for “transgender” individuals. In 2017, the city established the Office of Transgender Initiatives, whose mission is to link transgender, gender-nonconforming, and nonbinary residents with city services and various local resources. Its website provides connections to healthcare, housing, legal services, employment opportunities, and more. In 2022, the city launched a program called Guaranteed Income for Trans People (GIFT) that offered $1,200 per month for 18 months, as well as healthcare and financial coaching.

Furthermore, California’s Insurance Gender Nondiscrimination Act, implemented in July 2013, prohibits health plans and insurers from limiting benefits or coverage based on a patient’s gender, sex, gender identity, or gender expression. This law defines sex to include a person’s gender identity, gender-related appearance, and behavior, regardless of whether these characteristics align with the person’s sex at birth.

Finally, Medi-Cal, California’s taxpayer-funded public health program, covers hormonal and surgical sex procedures for its beneficiaries. As of January 1, this coverage was expanded to include illegal immigrants. The covered benefits encompass mental and behavioral health services, hormone therapy, and a range of surgical procedures. This also includes ancillary services, such as hair removal, related to these treatments.

In 2021, San Francisco Mayor London Breed proclaimed August “Transgender History Month.”