Trans activists speak out: What’s next for the trans community?

Across the county, transgender, non-binary, and gender expansive people are facing challenges and attacks to their healthcare, their rights, their stability, and their lives. In 2025, the Trump administration issued executive orders to limit trans healthcare, removed gender identity protections from the Affordable Care Act non-discrimination provision, instituted a ban on trans people from serving in the military, and reversed a decades-old policy of allowing transgender people to change their passport marker to reflect their true gender identity.

More recently, Trump administration health officials announced plans that will essentially end gender-affirming healthcare for transgender young people in hospitals across the country. 

“There is a tremendous amount of fear in the trans community right now,” said Honey Mahogany, director of the Office of Transgender Initiatives with the City of San Francisco. “Even for people who in this moment might be doing OK, there’s still a sense that they might need a backup plan in case things get even worse. Like, ‘What’s my escape plan in case I need to seek asylum in another country?’” 

“People are scared and concerned right now,” added trans advocate Maceo Persson. “We don’t know what to do, especially as it pertains to our legal and medical rights.” 

San Francisco is fortunate to benefit from strong rights and protections for transgender and non-binary residents, and a thoughtful and engaged community of transgender activists working to improve trans rights here and across the nation. We wanted to know–how are these community leaders responding? What issues are they keeping an eye on, and what advice do they have for the larger Queer community and allies on how to get involved?

Persson, vice president of San Francisco Pride and leader at San Francisco’s Department of Disability and Aging Services, has been involved in trans activism since he was a college student in Eugene, Oregon. There, he worked to pass nondiscrimination laws in the state, and facilitated an intergenerational group of trans residents supporting one another to find inclusive healthcare, access documents, and coach each other through tough times. Since, he’s worked in California to streamline processes for updating documents and changing vital statistics records through the Transgender Law Center, and he worked on the Our Trans Home Campaign at the Office of Transgender Initiatives to get trans inclusive housing programs in San Francisco.

“We’ve made so much progress over time,” Persson reflected. “I remember when you had to have evidence of surgery to change your gender marker. Or publish your name in the newspaper. We have the blueprints for how to create change. But it’s so heartbreaking to backslide on progress we’ve made in the last 30 years. It’s heartbreaking.” 

“Heartbreaking,” is also the word trans advocate, community organizer, and political strategist Jupiter Peraza uses to describe the current moment–particularly around the ways in which transgender people and trans youth are losing access to health care. 

“It is deeply crushing. And incredibly alarming and traumatic for young trans people,” she said.

Mahogany said that even among people who have privilege and access to healthcare, there’s a palpable fear that access may not last. 

“Everyone is rushing to get any gender-affirming surgeries done now,” she said. “They’re afraid that care will be taken away from them in the future.” 

Access to healthcare is top-of-mind for Mahogany, although she’s quick to point out that it can be difficult to pinpoint only one issue that matters most for the trans community right now. 

“All of these issues are important, but I think access to life-saving healthcare is the most basic, foundational need,” she said. “We know that there’s a correlation between access to care and depression, suicide, substance abuse, and overall happiness and fulfillment. There are now 27 states with trans health care bans… and counting.” 

Although no laws have been passed in California to limit healthcare for trans people, access is being limited through federal actions, hospital policy changes, and coverage decisions by health insurers. In 2025, large California hospital systems made decisions to preemptively scale back and end gender-affirming care programs for young people over fear of losing Medicaid reimbursements from the federal government. 

One thing Mahogany points to is the need for increased focus, awareness, and activation at the state level. 

“We’ve seen that the state legislature has been largely successful at passing protections for trans people, support for PrEP, and harm reduction. The state has a lot of power and resources. We have to be aware of what’s happening at the state level and continue to support these efforts through organizing and advocacy,” she said.