Following a contested primaries on August 25, 2018, the Democratic Party nominated Lou Leon Guerrero, a former Bank of Guam CEO, territorial senator, and 1998 lieutenant gubernatorial candidate.

The campaign centered on issues including abortion rights in Guam, ethical matters, and the role of the tourism sector.

Leon Guerrero's running mate, Josh Tenorio, accused the Republican nominee of having a conflict of interest issues regarding a pay increase bill.

Republican nominee Ray Tenorio, who was born to a white family in Florida, criticized her remarks, asking "Does Lou really care about all Guamanians" in a campaign ad.

[14] The Democratic Party of Guam rejected these criticisms, stating in a press release that "Ray Tenorio and his team are desperate and will grab at untruths and lies for their campaign".

Cristobal argued that the criticism of Leon Guerrero's remarks fail to appreciate "the political nuances of indigenous CHamorus in a colonized homeland".