As gender-affirming care grows ever-more politicized, efforts to ensure access have become a question of civil liberties in San Francisco.
Gender-affirming care (GAC) involves a range of social, psychological, behavioral and medical interventions — from counseling and social support to hormone medication and surgery — to support a person when the gender they identify with conflicts with the gender they were assigned at birth.
Demystifying ‘Protect the children’
“Politically, ‘protect the children’ comes up time and time again as a scapegoat,” said Doctor of Nursing Sarah Lentz, director of nursing operations at Dignity Health, at a Monday, September 23 panel about GAC as part of a United Against Hate Week summit at San Francisco’s Commonwealth Club.
“We start to formulate our identities as early as three months old,” she continued. “But if a six year old told me they identified as a gender other than that they were born with, I’d have the same conversation I would if they said they were a dinosaur, in that they’re exploring themselves at this time. Let them.”
“But there comes a question of when we take it seriously and intervene or don’t,” Lentz added. “That’s where the controversy lies: What’s right or best for the youth?”
Although data is limited, a UCLA Williams Institute study estimates that nearly 50,000, or around 2% of high school aged Californians (between ages 13 to 17) identify as transgender.
In the U.S. overall, 300,000 youth aged 13 to 17, or 1.4%, identify as transgender. 39.4% of them live in one of the 26 states that have passed bans on GAC.
Of the 1.6 million people aged 13 and over who identify as transgender (0.6% of the U.S. population), one in five are between the ages of 13 and 17.
Under California law, licensed health insurance plans are prohibited from discriminating against transgender patients; this includes denial of access to GAC to youth when the treatments are “medically necessary.”
California law also forbids the elective sterilization of people under the age of 18 — “So we don’t do that at all,” Lentz said, adding that the World Professional Association for Transgender Health releases standards of care adopted internationally “to increase safety for youth surrounding these health care interventions.”
94% of transgender and non-binary adults report that GAC bans make them feel unsafe, and 52.7% are considering moving to a new state due to passed or upcoming GAC bans.
“To me, good healthcare means everything that’s medically possible so that our kids can be who they really are,” said Katherine Thompson, CEO of nonprofit Family House. “I’m a parent of Clementine, a 23 year old graduate student studying to be a therapist in New York City. She started coming out when she was 17 … We have people who turned away, places we can’t go.”
“So much of this hate is based in fear, and I’m trying to understand where the fear comes from, and understand that there’s been fear in myself,” she continued. “The arc of transition is very long. It’s your whole family’s life, and we’re on this journey together. The bad stuff’s out there, and we’re trying to share our stories so everything feels less scary and more normal.”
Expanding protections
“When someone comes with a discrimination complaint, sometimes the other party is malicious, but often there’s just ignorance, and they’re embarrassed not to have known what they did had such an impact,” said Jude Diebold, mediator for the San Francisco Human Rights Commission.
They said the Commission is currently trying to expand the city’s Fair Chance Ordinance — which prohibits employers from asking about arrest or conviction records until after a conditional job offer, and prohibits any consideration of convictions that are non-felony, non-misdemeanor, juvenile, inoperative or for decriminalized conduct like cannabis cultivation — to include “things that are criminal in other states,” like youth GAC access, “which includes being able to use a bathroom or play on a sports team that corresponds to your preferred gender identity.”
Among the 26 states limiting youth access to GAC, five have made it a felony and 17 are facing lawsuits.
“With increasingly creative attacks across the nation to criminalize something so basic to civil liberties as being allowed to be yourself, we’re trying to be creative in expanding those protections,” Diebold said. “If we can’t depend on the Supreme Court to overrule these attacks, we have to bring it back to the city and state level with the hope that it spreads. All we’ve ever had is each other, so we have to bring that work home.”
‘The vehicle for me to live an authentic life’
“I lived a large part of my life as a white male, and I read about other people’s experiences of hate. I went to Howard Law School because I wanted to be involved in the struggle for their civil rights, but I didn’t really feel it,” said Suzanne Ford, executive director of SF Pride.
“Now, most mornings, one of the first news stories I read is about anti-trans legislation. I didn’t understand how debilitating it is to be made to feel like there’s no hope,” she continued. “They say it doesn’t happen here in the Bay Area, but when I came out my family was kicked out of their church in Novato. We’re not in a bubble.”
Anti-transgender hate crimes increased by 40% from 2021 to 2022 alone, according to FBI data.
Even as violence overall has begun to drop since then, LGBTQ+ hate continues to spike.
In 2023, the FBI reported 2,402 incidents relating to sexual orientation, up from 1,947 the year before; and 547 incidents relating to gender identity, up from 469.
In 2023 and in 2022 — which saw the highest number of LGBTQ+ hate crimes in five years — nearly one in five of all hate crimes were motivated by anti-LGBTQ+ bias.
“Gender-affirming care was the vehicle for me to live an authentic life. I didn’t know it was possible to ever stand up in a crowd of people as who I really was,” Ford said. “I was so lucky. The best surgeons in the world are in San Francisco. I found mental health care where I didn’t have to defend the dysphoria and hate I was facing … That opened up a new world to me where I wasn’t ashamed and policed about how I present myself anymore.”
“On June 30, we walked down Market Street in San Francisco with over half a million people lined up,” she continued. “In the ‘70s, Walter Cronkite would come on TV and once a year they’d show a picture of the SF Pride Parade, not for you to be like ‘Wow’ but so you’d be upset or shocked, like ‘Look at those terrible people.’ And I sat there as a little kid going, ‘Oh my god, if I could get out there.’”
“When you walk at the front of that parade, you feel that here, we’re not just tolerated. We’re in the fabric of the city,” Ford added. “And big cities in Kentucky or Alabama now are more like San Francisco than they used to be. I think eventually we’re going to win … in living vibrant lives and calling people to join in.”
This resource is supported in whole or in part by funding provided by the State of California, administered by the California State Library in partnership with the California Department of Social Services and the California Commission on Asian and Pacific Islander American Affairs as part of the Stop the Hate program. To report a hate incident or hate crime and get support, go to CA vs Hate.
