Democratic governors and state lawmakers across the country are mobilizing against a surge of Republican restrictions on transgender health care by establishing their states as sanctuaries for gender-affirming care.

Earlier this month, Democratic Gov. Wes Moore signed an executive order making Maryland the 11th state, plus the District of Columbia, to declare itself a sanctuary. A bill in New York has cleared the legislature and is awaiting the signature of Democratic Gov. Kathy Hochul.

Last year, California became the first state to declare itself a sanctuary. It has since been joined by Colorado, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, Vermont and Washington. A growing number of cities, including New York City; Kansas City, Missouri; and West Hollywood, California, also have become sanctuaries.

These states and cities are emerging as havens with legal protections to shield health care providers, transgender people and their supporters from lawsuits and criminal penalties levied by other states.

Maryland’s executive order prohibits the use of state resources, such as incarceration facilities, to comply with subpoenas against transgender people and their health care providers. It mandates that all state agencies “take whatever action is necessary” to protect those involved in providing, receiving or assisting in travel for gender-affirming care.

The order also ensures that transgender people will not be extradited from Maryland for seeking gender-affirming care, and doctors will not lose their licenses for providing such care. Similar measures have been implemented by other sanctuary states.

New York Democratic Assemblymember Harry Bronson, who led the effort to pass the sanctuary bill in the lower house, highlighted his state’s commitment to embracing and protecting transgender people.

“That’s what New York state is saying by this piece of legislation, that we love you for who you are, and we’re going to support you for who you are,” Bronson said in an interview with Stateline. “We’re going to make sure that whatever legal means we have, we’re going to make sure that you’re protected from those who will hate.”

Republican-led efforts to curtail or criminalize providing or receiving gender-affirming medical treatment have gained momentum in recent years, fueled by concerns over parental rights, religious beliefs and the ongoing debate surrounding gender identity.

At least 20 states have restricted or banned gender-affirming care for minors, according to data from the Movement Advancement Project, a nonprofit think tank that advocates for LGBTQ+ rights.

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