For transgender people in Hawaiʻi, the question is no longer whether their care is supported. It is whether it will remain protected.

Across the country, federal actions targeting transgender people are creating fear and instability for patients, families, and healthcare providers alike. In just the past year, transgender people have seen their ability to serve in the military restricted, their passports limited, and access to medically necessary care increasingly politicized.

In 26 states, bans on pediatric gender-affirming care threaten providers with loss of licensure, funding, or even incarceration. One executive action goes so far as to erase transgender, intersex, and nonbinary people from federal policy altogether.

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In moments like this, state leadership matters. While legal challenges to harmful federal actions are necessary, they are not sufficient. Hawaiʻi must act affirmatively to protect access to healthcare and the providers who deliver it.

In February 2025, Hawaiʻi’s Senate Ways and Means Committee unexpectedly tabled legislation during the legislative session that would have provided much-needed legal protections for institutions and organizations providing care for patients seeking access to gender-affirming healthcare. Other West Coast Health Alliance states (California, Oregon, and Washington) and over a dozen others have those protections.

We commend Gov. Josh Green for subsequently joining other governors in a lawsuit challenging federal actions that restrict healthcare access for trans, intersex, and non-binary youth. The American Medical Association, the American Academy of Pediatrics, and the American Association of Clinical Endocrinology are among the professional organizations that continue to oppose criminal and legal penalties against patients, family members, and healthcare providers.

Amid this uncertainty, there are still places where affirming care is protected and expanding. At Hawaiʻi Health & Harm Reduction Center, gender-affirming care means providing patients with medically appropriate services such as primary care, hormone therapy, mental health support, care coordination, and help navigating insurance and social services, all delivered with dignity and respect.

In November 2025, HHHRC received a transformative $2.5 million gift to establish the Erin Pouline Investment for Gender Affirming Health, expanding access to these essential services for transgender, māhū, and gender diverse people across Hawaiʻi. This investment is not about politics. It is about ensuring people can access basic healthcare, reduce crisis-level outcomes, and live healthier, more stable lives in their own communities.

We firmly believe that gender-affirming care is health care. It is the care that allows people to live safely and honestly in their own bodies, guided by licensed healthcare providers and established clinical standards. This care supports a person’s ability to live in alignment with their gender identity, which is a protected category under Hawaiʻi’s non-discrimination laws.

Treating this care as anything less than healthcare invites political interference into medical decisions and places patients and providers at risk.

Without clear state protections, access to care will increasingly depend on geography, resources, and shifting political winds rather than medical need. Our leaders have both the authority and the responsibility to ensure that transgender people in Hawaiʻi can access healthcare without fear.

This is not a theoretical debate. It is a question of whether we will allow politics to override medical judgment, or whether Hawaiʻi will stand by its values and protect the health and dignity of all who call these islands home.