Pittsburgh is joining a list of so-called sanctuary cities for transgender health care. City Council unanimously passed legislation Tuesday that will protect gender-affirming care from out-of-state investigations, and that will put a damper on enforcement of any future Pennsylvania bans.
At least one trans activist, however, said that while she welcomed the protections, there was more work to be done.
The measures, sponsored by Councilors Barb Warwick, Bobby Wilson and Bruce Kraus, come as many states across the country weigh tough restrictions on trans health care, including hormone therapies and surgeries. In some states, parents who seek gender-affirming care for their minor children can suffer penalties.
“Trans rights are human rights, and now we've taken action to ensure those rights will remain secure in the City of Pittsburgh,” Warwick said in a statement Tuesday. “With more and more states enacting or considering restrictions on gender-affirming care, this legislation was necessary to ensure that Pittsburgh remains a safe and welcoming city for the LGBTQ+ community.”
Gender-affirming care encompasses a range of treatments, from medical procedures to psychological and behavioral interventions. Medical professionals report gender-affirming treatment is proven to decrease depression, anxiety and suicide attempts in trans individuals.
Warwick cited Wilson’s 2022 abortion protection ordinance as the blueprint for the new bills to protect trans individuals. Those protections came after the United States Supreme Court overturned Roe v. Wade.
As with the earlier package of legislation, one of the new bills would shield providers and patients from out-of-state criminal or civil investigations by prohibiting any city agency from aiding in those investigations. The other bill would seek to gum up the enforcement of any statewide ban that might be enacted in Harrisburg.
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.”
Pittsburgh joins Kansas City where similar protections for gender-affirming care became law in May. According to The Hill, a growing number of Midwest communities, including Cincinnati and Dane County, Wis., are passing gender-affirming health care protections, often in defiance of conservatives at the state level.
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.
Is Pittsburgh ready for more trans patients?
While health care protections are important for the LGBT community, one activist says the city hasn’t done enough to protect trans individuals in other critical ways. Dena Stanley, executive director of TransYOUniting, said the city could see a surge of trans patients similar to one that engulfed local abortion clinics in Western Pennsylvania last year — and have nowhere to house them.
“We're going to have an influx of people coming into our city," she predicted. "And there are no resources outside of gender-affirming care."
Pittsburgh has seen its homeless population steadily grow and become more visible in recent years. And trans people are disproportionately affected by housing instability.
According to a 2021 report from the Trevor Project, nearly 40% of transgender and nonbinary youth experience homelessness and housing instability. Data from the U.S. Department of Housing shows that the number of homeless transgender people in the U.S. increased 88% between 2016 and 2019.
Stanley said that while it was "amazing" to see support for gender-affirming care, the city could better stabilize the trans community by providing more permanent housing options and job opportunities.
“No one's going to be really worried about health care if you don't have anywhere to live,” she said.
Stanley also wondered why more trans community voices weren’t included in the city’s legislative process.
Warwick confirmed to WESA that her office did not collaborate with activists or community groups when crafting the bills. She cited the city’s abortion protections as what guided the language of her bills.
Stanley said that without addressing concerns like housing instability, lack of health insurance and unemployment, the bills won’t benefit a large section of the trans community.
"They’re doing things without putting plans and protections in place to actually protect trans people,” Stanley said. “It's performative.”
She also worries that if a wave of patients arrives in Pittsburgh to seek gender-affirming care, it could overwhelm an already fragile system of providers, forcing trans people already on waiting lists to delay their care even further.
“There are waits for months and months for all of these things because there are not a lot of doctors offering these services,” Stanley said.
On the other hand, mayoral spokesperson Maria Montaño, a trans woman, stressed that safeguarding patients also protects providers. She hopes that will result in more providers relocating to Pittsburgh.
“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.
Stanley stressed that although the city should do more to provide for the trans community, the protections are a win.
“I'm happy that … they did something for the care of our folks,” she said. “But at the same time, it's terrifying because … if we are this safe haven place, we're going to get an influx of marginalized community members and have nowhere for them to go.”
