Despite its well-established reputation as a sanctuary for the LGBTQ+ community, Nevada tends to leave transgender people looking for medical care feeling duped. 

What seems like an oasis for gender-affirming care is really just a mirage of a better life. 

Silver State Equality State Director André Wade has described Nevada as "poised to welcome providers and seekers of gender-affirming care," but providers who are willing to offer services to trans people, especially youth, are few and far between. 

In 2023, Nevada passed SB163, mandating that certain medical insurance policies, including Medicaid, must cover gender-affirming care to treat gender dysphoria. Despite enacting these protections, many medical providers operating in the state remain afraid to offer services to trans people due to aggressive attacks from red-state attorneys general, federal scrutiny and the lack of shield laws protecting our healthcare professionals across Nevada. 

State Sen. James Ohrenschall (D-Las Vegas) introduced SB302 in the 2023 legislative session, a bill that would have prohibited medical licensing boards from disqualifying or disciplining medical professionals providing gender-affirming care. Additionally, it would have prohibited the governor from surrendering individuals charged with a criminal violation in another state for receiving gender-affirming care in Nevada. 

Despite the bill passing the Assembly and Senate, Gov. Joe Lombardo vetoed it because, he said "it inhibits the executive branch's ability to be certain that all gender-affirming care related to minors comports with state law." Two years later, Ohrenschall introduced SB171, another attempt to establish protections for providers offering gender-affirming care. It passed both chambers, but was once again vetoed by Lombardo. 

Nevada passed other shield laws, such as SB131, in the same 2023 legislative session, which protects reproductive rights in Nevada from out-of-state legal action. It was written explicitly to protect providers from extraterritorial retaliation without inhibiting Nevada licensing boards from investigating and disciplining violations of state law. 

It seems that Nevada lawmakers are perfectly capable of drafting airtight shield laws when it comes to reproductive rights, protecting local doctors from out-of-state meddling while preserving local accountability. 

Yet when it comes to gender-affirming care, our legal skills apparently evaporate and standard statutory exceptions become incomprehensible. It's a convenient kind of amnesia, suggesting that the administration is less concerned with legal consistency and more eager to leave providers defenseless so the state can pre-emptively comply with future federal crackdowns. 

Today, medical providers offering care to trans people operate under intense anxiety or have altered their practices and turned trans people away altogether to avoid legal battles such as those initiated by Texas Attorney General Ken Paxton (R) against Seattle Children's Hospital and QueerMed clinic in Georgia over gender-transition treatments and gender-affirming care. Paxton was hardly triumphant — Seattle sued and ultimately settled, and QueerMed refused his request. Nonetheless, this kind of red-state legal overreach destabilizes Nevada's healthcare environment, intimidating providers and interrupting their delivery of routine, essential care.

On top of an overall shortage of medical providers in Nevada, finding a provider willing or qualified to offer gender-affirming care is strained even further. 

Dr. Michael Uzmann is one of the few Nevada medical professionals still offering care to the trans community and, he says, the last locally practicing endocrinologist willing to assist parentally consented minors. Prior to opening his practice in July 2025, Uzmann spent five years navigating restrictive Las Vegas practices where primary care providers have long avoided gender-affirming care altogether, with one major group even slapping a predatory "subscription fee" onto hormone therapy rather than offering standard care, as he told me in an email exchange. 

He added, "To safely practice without fear of out-of-state retaliation, practitioners need policy protections that bar Nevada state agencies from assisting with out-of-state subpoenas, medical record requests, criminal investigations or extradition related to legally provided care."

Uzmann noted that many of his peers have either shut down their practices or quietly withdrawn from offering care to trans patients. Following the temporary closure of Huntridge Family Clinic, a Las Vegas leader in gender-affirming care, Uzmann reported that he received an influx of roughly 300 new transgender patients. That speaks volumes about the abundance of trans people in our local community and the shortage of doctors willing to provide them medical care. 

Dr. Julpohng Vilai, a Las Vegas-based pediatrician, has also heard from his patients about how difficult it has become to find pediatricians that offer gender-affirming care to transgender youth. Due to this major shortage, many minors don't seek the care that they need because they don't know where to find it — and if they do, not all willing providers are equipped or knowledgeable enough to provide them adequate care. According to Vilai, fear of legal retaliation pushed already-reluctant pediatricians across the state to stop accepting trans patients entirely.

According to a 2026 SafeHome.org study analyzing legal protections, healthcare access and hate crime data, Nevada earned the top spot as the safest state for LGBTQ+ individuals. It's an appealing safe haven on paper, but for trans people relocating here, escaping systemic discrimination comes with the hidden cost of stepping directly into a medical desert.

A 57-year-old transgender man who relocated with his spouse from the Midwest told the Las Vegas Weekly that he was drawn to Nevada by the LGBTQ+ safety ratings. Yet, despite gaining mandatory insurance coverage for gender-affirming care upon arrival, he quickly ran into the massive shortage of providers who understood how to care for a transgender patient. Gwendolyn Schwarz, a trans woman from Springfield, Missouri, left her home state for Carson City, where she hoped to receive her surgeries and live her life in peace. Stories about trans individuals such as Gwendolyn and their families fleeing their homes to states offering hope are increasingly common.

For many trans adults, Nevada offers a crucial baseline of everyday relief. One Southern Nevada medical student, a transgender man who moved to Las Vegas four years ago, told me that compared to states such as Texas or Florida, where using a public restroom carries felony risks, Nevada provides vital day-to-day safety. Yet, he acknowledges that his sense of security relies on being an adult navigating adult care.

For pediatricians, trans youth and specialists on the front lines, the absence of statutory shield laws leaves a far more pronounced vulnerability. "Without enshrined protections, there will always remain a risk of rights and access to care being lost," he explained.

It's safe to say that the harms created by our leaders refusing to protect the trans community and the medical care providers offering them healthcare far surpass the imaginary regulatory loopholes that Gov. Lombardo conjured up to justify his veto, proving that legal consistency matters a lot less to the executive branch when trans lives are on the line. 

It is imperative that the Legislature enacts dedicated shield laws to protect gender-affirming care. Navigating a medical transition is a yearslong process of clinical evaluation — decisions that should remain strictly between patients, their doctors and their families. 

No amount of political denial can erase the reality that trans Nevadans — our friends, family and neighbors — are an integral part of our community and deserve the same standard of care as anyone else. Dr. Terence McAllister, president of the Nevada Chapter of the American Academy of Pediatrics, is one of only 300 pediatricians serving more than half a million minors statewide. As Nevada officials search for a solution to the extreme healthcare shortage in the state, McAllister has stressed the necessity of implementing laws protecting providers as part of the remedy, echoing Ohrenschall and backing SB171. He also emphasizes how the restriction of gender-affirming care and social transition doesn't "protect" youth; it severely exacerbates depression, anxiety and self-harm.

Ultimately, calling Nevada a "sanctuary" state while leaving its patients and providers legally defenseless creates an unsustainable illusion. If Nevada leaders genuinely want to protect our community and solve our mounting provider shortage, they cannot disregard an entire segment of the population or leave the doctors who provide for them exposed to political prosecution. 

Statutory shield protections are not radical loopholes; they're baseline infrastructure for modern healthcare. Until the Silver State backs up its progressive messaging with ironclad legal safeguards, Nevada's reputation as a sanctuary will remain what it currently is for so many trans residents: a hollow promise. 

Lotus Gage is a Las Vegas-based writer, activist and advocate.