Hawaiʻi prides itself on being a welcoming and inclusive place where diverse communities can live as their authentic selves. The state has the highest percentage of youth who identify as transgender, according to data collected by the Hawaiʻi Department of Health.

This doesn’t mean there are inherently more transgender kids here than anywhere else; rather, it reflects Hawaiʻi’s deep-rooted culture of inclusivity, which acknowledges and honors gender diversity — including the historical recognition of māhū culture. In a more accepting environment, young people feel safer expressing their identities.

Despite this legacy of acceptance, our national government in Washington is attempting to impose nationwide restrictions on providing gender-affirming health care to anyone under the age of 20. Senate Bill 1150, currently being considered in the Hawaiʻi Legislature, aims to protect the state’s health care providers from this federal overreach.

If passed, the measure will ensure that local medical professionals and other health care entities can continue offering evidence-based, life-saving gender-affirming care without fear of legal repercussions or retaliation.

Caught In A Firestorm Of Misinformation

The debate over transgender youth and gender-affirming care evokes strong emotions — sometimes genuine, but often counterproductive. Public testimony has been heated, fueled by misinformation. Claims of “child mutilation” or “kids undergoing surgery without parental consent” would be rightfully concerning if they were true — but they are not.

These are deliberate falsehoods, designed to stoke fear and suppress the rights of transgender youth. Misinformation is a powerful weapon, misleading even well-intentioned people who believe they are acting in the best interests of keiki.

Here are the facts. Gender-affirming care is:

• supported by every major medical association and leading global health authority;
• evidence-based, safe, medically necessary, and often life-saving;
• only provided to minors with parental consent;
• for prepubescent (young) children, gender-affirming care may include: talk therapy, using different names or pronouns, non-medical changes in appearance (e.g., hairstyles, clothing), family counseling;
• for adolescents, care may include fully reversible puberty blockers, which temporarily pause physical changes (e.g., breast growth, facial hair) to allow individuals to reach adulthood and mental maturity before making decisions about more permanent options like hormone injections and surgeries.

What gender-affirming care does not include:

• it is not provided to minors without parental consent;
• it does not involve surgeries on minors.

“Surge” In Transgender Youth

A common misconception is that the rise in transgender youth is some kind of new fad. “Why does it seem like more young people are identifying as transgender now? This never used to be a thing!”

If you’ve wondered this, history provides an explanation.

Take the case of left-handedness. Before 1900, most naturally left-handed children in America were forced to write with their right hand. Schools, parents, and society at large viewed left-handedness as awkward, undesirable, or even a sign of poor character.

Dubious claims suggested it led to negative health outcomes or antisocial traits. As a result, left-handed children conformed out of pressure and fear.

But when these outdated beliefs faded in the early 20th century, something remarkable happened: the percentage of left-handed people appeared to skyrocket. Suddenly, kids were identifying as left-handed at much higher rates.

This led to backlash from older generations who saw it as an unnatural fad — “Why are all these kids choosing to be left-handed now? This never used to be a thing!”

Of course, the real prevalence of left-handedness hadn’t changed. The roughly 12% of people who are left-handed today had always existed; they had simply been hiding in plain sight. Once societal norms shifted, they finally had the freedom to live as they truly were.

The same logic applies today to gender identity. When a society suppresses something, it doesn’t erase it — it just forces people into silence. And when that suppression lifts, the truth emerges.

It’s Not Just About Health Care

Attacks on gender-affirming care extend beyond health care — they have far-reaching consequences for other marginalized groups and communities. History has shown that when governments restrict the rights of one vulnerable group, others soon follow.

Right now, our national government is targeting transgender youth. Protecting their access to care is about more than health care — it’s about drawing a line in the sand to keep Hawaiʻi a place of aloha, where no community stands alone when their rights are under attack.

SB 1150 is a necessary safeguard against federal overreach that threatens Hawaiʻi’s health care providers. It ensures that medical care in our state remains guided by science, compassion, and the well-being of keiki — not political ideology or misinformation.