It’s getting much harder to get gender-affirming care in the United States. To date, nearly half of states have banned gender-affirming care for people under 18 (though several of these bans are temporarily blocked). Despite lawmakers’ claims they want to “protect” children, some of these laws also affect care for adults, and an increasing number of new bills target adults directly.

All this hostility, combined with targeted threats and harassment, has led clinics to shut down. Some gender-affirming care providers have even left the field entirely.

But even before far-right politicians and hate groups made banning medical care for trans people a priority, there were barriers to gender-affirming care. And in Hawaii, lawmakers are considering a bill that would knock down one obstacle in particular: state-level restrictions that make it more difficult to prescribe testosterone. A state house committee will hold a hearing on the bill today.

Testosterone is a controlled substance, meaning it’s regulated under a federal law called the Controlled Substances Act. And under the 2008 Ryan Haight Act—named for an 18-year-old who died from an overdose of prescription drugs purchased online—providers are required to see a patient in person before prescribing any controlled substance via telehealth.

None of the other drugs typically used for gender-affirming care are regulated this way. These include puberty blockers, other hormones such as estrogen, and anti-androgens, meaning drugs that block the action of testosterone.

According to Dr. Crystal Beal, a family medicine physician, founder of the telemedicine practice QueerDoc, and a fellow with Physicians for Reproductive Health, there’s no medical reason why testosterone should be regulated differently from these other drugs. The rules create a “disproportionate barrier for people who want treatment with testosterone,” they said.

But during the pandemic, this barrier was partly dismantled: Under the COVID-19 Public Health Emergency, the Drug Enforcement Administration (DEA) waived the in-person requirement for controlled substance prescriptions—one of many temporary changes the federal government made to help people access medical care via telehealth.

This change didn’t just help maintain access to gender-affirming care during the pandemic; it allowed telemedicine to become a lifeline for trans people as states began to outlaw gender-affirming care. For example, Beal previously told Rewire News Group that their practice received a significant influx of new patients from Florida after that state’s gender-affirming care ban went into effect.

Hawaii has........

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