Transgender and gender-diverse people in Hawaii face increasing uncertainty about access to medical care as federal actions expand restrictions on healthcare services. According to advocates and providers, transgender people have recently seen military service restricted, passport options limited, and access to gender-affirming care increasingly politicized. In 26 states, bans on pediatric gender-affirming care threaten healthcare providers with loss of licensure, funding, or incarceration.
At Hawaii Health & Harm Reduction Center (HHHRC), gender-affirming care includes primary care, hormone therapy, mental health support, care coordination, and assistance navigating insurance and social services. 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 services for transgender, māhū, and gender-diverse people across Hawaii. Rick Ramirez, a triple board-certified nurse practitioner specializing in LGBTQ health, serves as the primary provider for HHHRC’s gender-affirming care clinic.
State Protection Needed
In February 2025, Hawaii’s Senate Ways and Means Committee tabled legislation that would have provided legal protections for institutions and organizations providing gender-affirming care. Other West Coast states—California, Oregon, and Washington—and over a dozen other states have enacted such protections. The American Medical Association, the American Academy of Pediatrics, and the American Association of Clinical Endocrinology continue to oppose criminal and legal penalties against patients, families, and healthcare providers. Governor Josh Green subsequently joined other governors in a lawsuit challenging federal actions that restrict healthcare access for transgender, intersex, and non-binary youth.
Providers and advocates argue that state leadership is essential to protect access and prevent geography and resources from determining care availability. According to healthcare providers at HHHRC, gender-affirming care enables people to “live safely and honestly in their own bodies, guided by licensed healthcare providers and established clinical standards,” and supports alignment with gender identity, a protected category under Hawaii’s non-discrimination laws.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.civilbeat.org/2026/02/gender-affirming-care-is-health-care/