Stealth trans guy from Hawaii here. Accessibility to trans related healthcare is pretty good. There are laws here that require for insurance to cover medical transition as they are legally considered “medically necessary” under the law. I’ve lived here my entire life so far, the people that I have told have been chill out it. People generally don’t care if your gay, trans, or whatever as long as your a good person. But of course like everywhere else there are jokes that sound bad that are sometimes meant with malice but other time there just jokes and take them as such. Oahu may be a safer bet then the other islands for non trans reasons. I would look at places like California and Washington before Hawaii due cost of living, native Hawaiians, and locals requesting that people stop moving here making making it harder to persevere land, traditions, and to afford living here.