Pittsburgh could become a sanctuary city for transgender health care. A package of bills introduced in City Council Tuesday would prohibit city agencies from supporting investigations by other states where certain gender-affirming care practices are prohibited. The legislation could also stall enforcement of any potential ban in Pennsylvania.
Councilor Barb Warwick, who sponsored the bills, said the protections are critical as trans health care becomes a political football nationwide.
“Given the number of bills coming into states around the country … that are proposing criminalization of gender-affirming care, we wanted to make sure that type of care is protected here in the City of Pittsburgh,” Warwick said.
One bill would shield providers and patients from out-of-state criminal or civil investigations: It would prohibit any city agency from helping to investigate the receipt or provision of gender-affirming services.
A second bill safeguards treatments if a Pennsylvania-wide ban were ever to take effect. The bill instructs city officials and police to "deprioritize enforcement of crimes related to providing or receiving gender-affirming health services to the furthest extent possible.”
The bills, which are also sponsored by council members Bobby Wilson and Bruce Kraus, are modeled after legislation passed last year to protect abortion rights in city limits. The abortion protections came after the United States Supreme Court overturned Roe v. Wade.
Pittsburgh leaders are also following in the footsteps of Kansas City, where similar protections for gender-affirming care became law in May.
On Tuesday, Warwick urged Allegheny County officials to pass similar legislation, which would protect gender-affirming care county-wide.
“Trans rights are human rights, and we cannot call ourselves a welcoming city for our LGBTQ+ community if we don’t take proactive action to protect these rights when they are under attack,” she said.
Gender-affirming care encompasses a range of treatments, from medical procedures to psychological and behavioral interventions. Medical professionals say gender-affirming treatment has been proven to decrease depression, anxiety and suicide attempts in trans individuals.
Mayor Ed Gainey’s spokesperson Maria Montaño, a trans woman, said gender-affirming support can mean the difference between life and death.
“This health care saved my life,” she said. “If it wasn't for my ability to receive the kind of care I need to be who I am — my full, authentic self — I don't think I could serve in the role that I do today.”
But these treatments, and trans people in general, have been the target of mounting political attacks. A Reuters investigation found that 142 bills restricting gender-affirming health care have been introduced in 37 states this year alone.
Anti-trans political ads were broadcast on Pittsburgh radio airwaves late last year, with graphic descriptions of children and gender-confirmation surgeries.
Bills restricting trans rights in Pennsylvania have passed one or both chambers in recent years, but have not become law. Former Gov. Tom Wolf vetoed a measure that would have banned colleges from allowing transgender athletes to compete in sports that align with their gender identity. A similar bill was reintroduced this spring.
Regarding medical restrictions, one bill currently under consideration in the state House would extend the statute of limitations for minors who received gender affirmation treatment to sue their care provider for medical malpractice.
Much of the political rhetoric around transgender health care centers on pediatric procedures, though it’s rare for providers to perform surgical interventions until the patient is an adult.
According to Montaño, gender-affirming care for children is often just supporting their social transition, which could include a name change, a haircut and dressing differently.
“It's not the case that a kid can just talk to their doctor and say, ‘Hey, I'm trans,’ and get hormones and surgery in the next two weeks,” she said. “That is just not something that happens.”
Central Outreach, a Pittsburgh-based medical clinic prioritizing LGBTQ health care, applauded the legislation Tuesday. Central Outreach often assists patients struggling to navigate Pittsburgh’s health care systems.
“This measure is an important step in protecting the lives of gender diverse people and the lifesaving healthcare we are proud to be able to provide,” said Remy Black, the group’s gender-affirming care patient navigator. “Access to gender-affirming care should be a human right, not a political rallying point.”
The range of gender-affirming procedures available in Pittsburgh is limited. A Public Source investigation found that care for trans patients is difficult to access and often inconsistent.
“There's a variety of places to receive things like hormone replacement therapy… top surgery or facial feminization surgery,” Montaño said. But a list of resources offered by Central Outreach does not include a single provider in the region for bottom surgeries.
Montaño is hopeful that if the package of bills passes, more providers may come to Pittsburgh, and health care offerings for trans people could expand.
“We would welcome [providers] with open arms and say, ‘This is a place where not only will you be protected, but the people that you serve will be protected as well,’” she said.
