City Council
Report
City Council Meeting: March 25, 2025
Agenda Item: 4.E
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To: Mayor and City Council
From: Douglas Sloan, City Attorney, City Attorney's Office, Administration Subject: Adoption of a Resolution Protecting Access to Gender-Affirming Healthcare Recommended Action
Staff recommends that the City Council adopt the attached resolution protecting access to gender-affirming healthcare and preventing city resources from assisting investigations into transgender, gender diverse, and intersex persons (“TGI”) and their healthcare.
Executive Summary
As a result of community concerns surrounding the President Trump’s recent TGIrelated Executive Orders, on February 25, 2025, Council directed staff to prepare a Resolution for its consideration affirming the City’s commitment to the protection of TGI persons and their right to choose to receive gender-affirming medical care. The proposed resolution reaffirms the City’s values of embracing diversity and rejecting hate and discrimination against TGI persons in our community. The proposed resolution would specifically prohibit the use of City resources and personnel to aid the federal government, or other states, in doing any of the following: blocking gender affirming health care; requiring the unlawful registration or detention of individuals; creating a database of gender-affirming activity; obligating the City through contract to perform any law enforcement activity, such as registering or detaining any individual simply because the person engaged in a gender-affirming care-related activity; or sharing any data that may contain any of this information.
Background
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The first few weeks of the current federal administration have been marked by several Executive Orders that attack TGI dignity and full participation in society, and which threaten access to healthcare and gender-affirming care for TGI adults and minors, including the following:
• Executive Order 14168, signed on inauguration day January 20, 2025, declares it to be the policy of the United States to recognize only two sexes, purports to cease funding for “gender ideology,” and directs federal departments to implement changes to require that government-issued identification documents reflect the user’s sex and not gender, among other things. • Executive Order 14187, signed January 28, 2025, seeks to prevent individuals under the age of 19 years old from obtaining gender affirming care by withholding federal funding and directing agencies to take a variety of steps to end surgeries, hormone therapy, puberty blockers, and other components of gender-affirming care.
• Executive Order 14190, signed January 29, 2025, threatens federal funding for educational institutions that support social transitioning for transgender youth.
Many states have also instituted policies hostile to gender-affirming healthcare.
Currently, 26 states have laws or policies banning gender affirming care. The US Supreme Court is considering Tennessee’s ban on gender-affirming care for minors and is expected to issue a decision in the coming months.
On the other side, California and Santa Monica have sought to expand and protect rights of TGI individuals and their access to care through legislative actions including the following:
• In 2016, the State of California passed AB 1732, enacting the most progressive restroom access policy to date, requiring all single-occupancy restrooms in businesses, government buildings and places of public accommodation to be labeled as “All Gender,” “Unisex,” “Gender Neutral,” or something similar, and available to everyone.
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• In 2022, the State of California passed SB 107, which protects individuals seeking sanctuary from out of state prosecution and explicitly prohibits law enforcement agencies from knowingly making or participating in the arrest or extradition of an individual pursuant to an out-of-state arrest warrant based on another state's law against receiving gender affirming healthcare in California. • In 2023, California began implementing SB 923, the “Transgender, Gender Diverse, and Intersex (TGI) Inclusive Care Act,” which protects the right of Californians to access gender-affirming healthcare services, including a health insurance coverage mandate.
• On April 25, 2023, the City Council unanimously adopted an ordinance, and associated design standards, to require multi-stall gender neutral public restrooms for all newly constructed buildings for which a complete building permit application is submitted to the City on or after July 1, 2023.
The City is committed to transgender equity and has enacted policies to promote this commitment, including providing health plans that offer gender affirming care health benefits to all covered employees; adoption of an all gender restroom building ordinance that requires all new multi-stall restrooms be designed to be gender neutral; supporting LGBTQ+ youth, including protections in the City’s anti-bullying policy that cover sexual orientation and gender identity; and, striving to ensure access to restrooms and recreational programs based on gender identity, not perceived or birth gender. The City’s Out in Santa Monica affinity group supports the Trans Equity Scholarship, in partnership with the LA LGBT Center’s Trans Economic Empowerment Project, to help support those seeking to make their gender and name change official in government records.
Santa Monica also has a history of affirming its commitments to diversity, equity, and inclusion and adopting policies to protect those targeted by federal policies hostile to these values. On February 28, 2017, in response to the first Trump administration’s executive orders attempting to require state and local governments to enforce federal immigration laws and policies, the City Council reasserted its commitment to protecting undocumented residents in Santa Monica by adopting Resolution 11028 titled “A 4 of 7
Resolution of the City Council of the City of Santa Monica Embracing Diversity, Rejecting Hate and Discrimination, Clarifying the City’s Role in Enforcing Federal Immigration Law, and Promoting an Environment in Which Fear and Intimidation Do Not Chill Cooperation with Law Enforcement and Other First Responders” (“Resolution 11028”). With Resolution 11028, Council resolved that the City would not use any monies, resources, or personnel to enforce federal civil immigration laws or to support any federal program requiring unlawful or unconstitutional registration or detention of individuals based on religious affiliation, race, national or ethnic origin, immigration status, gender, sexual identity or orientation. Council further resolved that the City staff shall not, in their official capacity, aid in the creation of a registry or database based on these characteristics, and shall not share data that may be collected that contains such information.
At the Council meeting on February 25, 2025, in recognition of the federal government’s and other states’ attacks on TGI persons, their healthcare, and gender-affirming care, Council directed staff to draft a resolution to reaffirm the City’s commitment to safety and protections for TGI persons, their loved ones, and healthcare providers who seek or provide gender-affirming care at Santa Monica hospitals and clinics.
Discussion
The City Council could further extend its commitment to transgender equity by adopting the proposed resolution supporting and protecting TGI persons’ access to genderaffirming healthcare. Gender-affirming care, as defined by the World Health Organization, encompasses a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity” when it conflicts with the gender they were assigned at birth. The interventions help TGI people align various aspects of their lives—emotional, interpersonal, and biological—with their gender identity. As noted by the American Psychiatric Association (APA), that identity can run anywhere along a continuum that includes man, woman, a combination of those, neither of those, and fluid. Interventions fall along a continuum as well, from counseling to changes in social expression to medications (such as hormone therapy). 5 of 7
Gender-affirming care is also essential to the health and wellness of many transgender and non-binary people. Major medical organizations that collectively represent over 1.3 million doctors in the United States, including the American Medical Association, the American Academy of Family Physicians, and the American Academy of Pediatrics, recognize the medical necessity of age-appropriate gender-affirming care for transgender and non-binary people.
Studies from numerous institutions including Stanford and Yale Universities have shown that gender transition, including access to gender-affirming healthcare, improves the overall well-being of transgender people and access to gender affirming healthcare for youth is associated with better mental health outcomes and lower risks of suicide.
For children, in particular, the timing of the interventions is based on several factors, including cognitive and physical development as well as parental consent; surgery, including to reduce a person’s Adam’s Apple, or to align their chest or genitalia with their gender identity, is rarely provided to people under 18.
As noted above, since his inauguration to a second term, on January 20, 2025, the Trump administration has issued several Executive Orders that explicitly attack TGI healthcare and gender-affirming care for both adults and minors.
California laws do protect TGI persons’ rights in many respects: They require access to gender-affirming healthcare; access to multi-stall gender neutral public restrooms; protect individuals seeking sanctuary from out of state prosecution for seeking or providing gender-affirming care; and explicitly prohibit law enforcement agencies from engaging in activities related to arresting, detaining or extraditing individuals targeted by out-of-state arrest warrants enforcing non-California laws prohibiting receipt of gender-affirming healthcare in California.
Despite these protections, there are increasing concerns among the LGBTQ+ community that, as seen with immigration and reproductive health care, federal or otherthan-California state investigations will be launched against individuals seeking genderaffirming care, those aiding individuals seeking such care, medical providers providing such care, and organizations that fund such care, particularly those that cross statelines to do so. 6 of 7
Accordingly, as directed by Council, staff has prepared a proposed resolution to reaffirm Council’s commitment to safety and access to gender-affirming care for all TGI persons.
The proposed resolution mirrors Resolution 11028 and would do the following:
• Prohibit the use of City resources to investigate, question, detect, apprehend detain or register person whose only violation is or may be a violation of civil provisions of federal executive orders or laws related to gender-affirming care; • Prohibit the use of City resources in support of any federal program requiring unlawful or unconstitutional registration or detention of individuals in relation to accessing gender affirming care;
• Prohibit the City and its staff from aiding in the creation of any registry or database based on the acts of seeking gender-affirming care; and • Prohibit the City and its staff from entering into any agreement that obligates the City to perform any law enforcement functions to enforce violations of civil provisions of federal executive orders, federal laws, or other states’ laws related to gender-affirming care.
This Resolution will ensure that the City does not allow law enforcement or City resources to aid federal investigations and law enforcement actions targeting individuals who seek or provide gender-affirming care.
Financial Impacts & Budget Actions
There is no immediate financial impact or budget action necessary as a result of the recommended action.
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Prepared By: Romy Ganschow, Chief Deputy City Attorney
Approved Forwarded to Council
Attachments:
A. CAO-Gender Affirming Care-Reso
B. Item 16 Re Gender Affirming Care
C. Written Comments