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Obstetrician-gynecologists (OBGYNs) are often involved in caring for transgender patients but may not be equipped with knowledge about transgender-specific care. The aim of this study was to assess the knowledge base and comfort level of OBGYNs in Hawai'i with regard to health care for transgender people. This was a cross-sectional survey of OBGYNs in the American College of Obstetricians and Gynecologists (ACOG) Hawai'i section. The survey was distributed in-person and electronically to a listserv of OBGYNs between October 2017 and August 2018. This survey assessed practice environment, experience with transgender care, and knowledge of health care needs and recommendations for transgender patients. The response rate to this survey was 28%. Approximately half of respondents worked within the University of Hawai'i system and 47% were private practitioners. A majority (79%) of the respondents had unisex restroom facilities in their offices; however, only a fifth of respondents had gender-inclusive intake forms. Respondents were more comfortable providing care for trans men, people who were assigned female sex at birth but identify as male, compared to trans women, people who were assigned male sex at birth but identify as female (53% vs 38%). Knowledge of preventive care was variable. Most respondents had limited knowledge regarding gender-affirming hormone therapy and requirements for gender affirming surgery (67% and 52% respectively). Despite their limited experience, OBGYNs in Hawai'i demonstrated a willingness to provide care for transgender patients. Efforts should be made to educate OBGYNs on quality care for transgender people, particularly gender affirming hormone therapy., (©Copyright 2022 by University Health Partners of Hawai‘i (UHP Hawai‘i).)