George Bracey Jr. has had to fight for her life more than most. The 72-year-old fought in Vietnam, and battled post traumatic stress disorder and addiction to drugs and alcohol upon her return home. In subsequent years, she’s faced HIV and cancer.
Another struggle has been accessing gender-affirming care as a transgender woman.
Bracey moved to San Francisco in the ’80s because she was living as a gay man, and the city seemed welcoming. “I moved to San Francisco because it was the ideal place for me as a Black gay person to be instead of being in the Midwest,” she said.
San Francisco has long been a haven for LGBTQ+ people, and in 2024 the city declared itself a sanctuary city for transgender, gender-nonconforming, intersex and two-spirit people. Transgender residents interviewed by the Public Press say this remains a comparatively safe place for them among U.S. cities as anti-trans bills proliferate. Local service providers have noticed that more trans people, or families with trans loved ones, are considering, or actually pursuing, relocation to the city. But federal decisions are cutting off trans people’s access to health care services and benefits and denying immigrants due process, putting trans immigrants at risk of incarceration or deportation. The administration is also pressuring local governments and providers to follow suit.
In 2015, Bracey began transitioning. During Donald Trump’s first presidency, she had to postpone gender-affirming surgical procedures until Joseph Biden came into office to gain access to care. Though she tried to pursue her transition through the Veterans Administration health care system, she said employees told her that gender-affirming surgeries were not covered. She turned to community-based organizations. Today many other trans people are doing the same, causing the demand on those organizations and local governments to surge. Advocates want to see the city do more to protect these residents.
“We’re never going to be able to do enough,” said Honey Mahogany, director of the city’s Office of Transgender Initiatives. “There’s so much more I would love to be able to do. I’m continuing to work with the current [city] administration to do more for our community, because I think it is one of the most vulnerable, it is the one of the ones being most targeted by the federal administration.”
Facing persecution, people seek refuge in SF
The city’s status as a beacon for LGBTQ+ people across the world is reflected in the growth of its transgender population over the past few years.
Mahogany cited 2023 estimates by the Office of Transgender Initiatives that about 3% of San Francisco’s population is trans — roughly double what one would expect in the general population. At that time, state houses across the country were proposing anti-trans legislation. Under the Trump administration, restrictive legislation has given way to orders and policies attacking transgender care, rights and liberties.
Mahogany noted also that El/La Para Translatinas, a local organization that focuses on the needs of trans people from Latin America, has seen a 43% increase in the number of people it serves.
“There are more and more trans people feeling far less safe in their home states,” Mahogany said. “They tend to be red states.”
Organizations that serve trans immigrants noted that they are increasingly seeing clients come from other states to the Bay Area, as opposed to arriving directly from their home country.
“Coming here, regardless of where you enter in the United States, is often a goal, or often something that people plan to change once they experience harms and discriminations in other parts of the country that remind them of what they were fleeing from,” said Becca Holt, an attorney at Oasis Legal Services, a nonprofit that provides legal aid to LGBTQ+ people seeking asylum in the United States.
But San Francisco is an expensive place to live, so coming here is often a difficult decision.
“I think people come to San Francisco because they want to live in San Francisco, and then high housing costs and tight job markets, or job markets that require highly skilled labor, make it hard to — especially if you’re young — to make it,” said Sherilyn Adams, CEO of Larkin Street Youth Services, a nonprofit focused on homeless youth. Adams noted that most of the people her organization serves come from the Bay Area, but said the impacts of Trump’s anti-LGBTQ+ policies on client demographics might take time to become measurable.
Trans immigrants still face federal threats
Some who took financial and personal risks fleeing to San Francisco are nevertheless affected by federal attacks.
Holt, the attorney, described a transgender woman in her late 60s from Latin America who faced sexual and police violence and fled to the United States in the ’90s. Though she is applying for asylum, her case is stuck in a backlog. She suffers from PTSD and fears leaving her home, as she sees reports of violent Immigration and Customs Enforcement arrests and deportations without due process.
While city employees are not allowed to cooperate with ICE on immigration enforcement, providers said the city could do more to protect trans immigrants.
“How the city reacts when there are enforcement actions by the federal government within the city, and how the city mobilizes to protect people and provide information about ICE and other immigration enforcement actions, is an incredibly essential part of providing something that looks like true sanctuary,” Holt said. That applies, she said, to immigrants in general and to Oasis’ trans clients in particular.
Increasing threat to health care access
While a growing number of state legislatures are limiting or banning access to gender-affirming care for youth, California has increased protections for people seeking or providing this care in recent years, making the state desirable for trans youth and their families. The resolution declaring San Francisco a sanctuary city for trans people explicitly notes it is a place of safety for providers of gender-affirming care.
However, a slew of presidential executive orders have imposed barriers to health care access for LGBTQ+ people, including one in January designed to ban gender-affirming care for trans youth under age 19. In June, the Department of Justice subpoenaed health care providers that perform gender-affirming care for children, going so far as to demand individual patients’ personal records.
In response, regional health care providers are curbing access to gender-affirming care for trans youth, including Kaiser Permanente, which stopped providing gender-affirming surgeries this month, and Stanford Medicine, which stopped offering them in June. Registered nurses at Kaiser and members of the California Nurses Association fear this is just the first step in a plan to put broader limits on the many forms of gender-affirming care for all ages, from mental health counseling and vocal coaching to puberty blockers and surgery.
“The concern is that if we’re taking a step away from evidence-based care,” said Sydney Simpson, a registered nurse at Kaiser, “then what’s to stop us from then rolling back services for adults?”
Trans veterans and service members facing discrimination
In January, President Trump issued an executive order banning trans people from serving in the military and discharging existing members. The Air Force announced in August that it is denying retirement packages to some personnel being forced out. It’s unclear whether and how benefits for veterans of other branches will be affected.
A 2014 study from the Williams Institute at UCLA found that transgender people are twice as likely to serve in the armed forces as the general adult population.
“A lot of folks go into the service for GI Bill education benefits,” said Mo Siedor, director of legal services at Swords to Plowshares, which serves veterans. “It’s a pathway to a college education that they may not otherwise be able to afford, and it necessarily requires a fully honorable discharge.”
Whether trans troops will receive an honorable or less-than-honorable discharge remains unclear. Though Siedor initially expected the former, she is increasingly doubtful, given the current climate of hostility toward trans people.
Even if trans people receive an honorable discharge, those kicked out with less than 24 continuous months of active duty will be ineligible for, or receive limited versions of, many of the benefits offered to veterans. These can include health care, education support, pensions, home loans and more, Siedor said.
Increased local and state role
For the trans people who live here and the service providers supporting them, San Francisco and California still offer greater protections than do many other places. But providers and community members said that with federal cuts looming and ongoing attacks on the trans community, the city and state need to increase support for a strong safety net, including health care and housing for trans people.
“One of the things I think the city is going to have to grapple with is, when those federal services dry up, what is going to happen to all those people who are currently residents of San Francisco who rely on those services?” Mahogany said.
State and local agencies should ensure access to jobs and education, and make sure people are easily able to navigate existing services, providers said.
“The need won’t change. It’s clearly probably going to increase,” said Adams of Larkin Street. “The city has a tight budget, and the state has a tight budget, and so I think we will all have to step up to continue to meet the need.” She said service providers should aim not just to meet basic needs, but also to provide hope and opportunity for people to thrive.
Simpson, the Kaiser nurse, helped organize San Francisco’s Trans March during Pride month. They emphasized the importance of community organizing “outside of the government, outside of corporations, all these entities that have absolutely never had our best interest at heart.” They were heartened to see almost twice as many attendees at this year’s march than expected.
Transgender San Franciscans are also drawing strength from the city’s long history of community, activism and resistance.
“We are the home of the Compton’s cafeteria riots. We’re the home of the first Transgender District. We’re the home of the one and only Office of Transgender Initiatives in the country,” Mahogany said. “I do think that San Francisco has a really important role in this moment in time and in our history, to serve as a refuge for trans people.”