How Colleges Can Support Gender-Affirming Care for Trans and Nonbinary Students

• Hundreds of anti-trans legislative efforts are currently active across the U.S.
• Access to gender-affirming healthcare supports students and saves lives.
• Colleges and universities can improve their students' health outcomes with gender-affirming care.

In just the first month of 2023, the number of anti-trans bills being considered across the country was twice the number of such bills considered in all of 2022. These bills seek to restrict trans and nonbinary people's access to public life, from athletics to education, from entertainment to healthcare and more.

Among those playing political football with trans people's lives is Florida Governor Ron DeSantis, whose "Don't Say Gay" bill is currently being expanded. DeSantis has ordered universities in Florida to hand over data about the provision of gender-affirming care and, along with legislators in several other states, has begun criminalizing gender-affirming care for youth and adults alike.

Gender-affirming physical and mental healthcare helps trans and nonbinary students feel more like themselves, boosting their ability to succeed. Federal efforts to increase protections for LGBTQ+ students in Title IX rules could help campuses resist state-level anti-trans laws and policies.

How Discriminatory Laws Harm Transgender and Non-Binary Students

Most major and reputable medical associations, such as the American Academy of Pediatrics, the American Public Health Association, and the American Medical Association, consider gender-affirming care to be safe, effective, and "medically necessary."

Restricting access to medically necessary healthcare diminishes the physical and mental health of trans and nonbinary people. In the pursuit of a safe, inclusive, and supportive campus environment for all students, colleges must support their students' health and well-being, including their needs for gender-affirming treatment.

Improving Health Outcomes with Gender-Affirming Care

Currently, trans and nonbinary students already face mental health systems that fail them both on and off campus. They face a variety of challenges, including:

• Inadequate or nonexistent insurance coverage
• Lack of culturally and technically competent health providers and staff
• Lack of funds and/or familial support
• Discrimination and harassment in healthcare settings.

These instances compound as they further dissuade trans and nonbinary people from accessing healthcare for any reason. The 2015 U.S. Transgender Survey — the largest survey for trans individuals, with more than 27,000 respondents —showed that nearly a quarter (23%) of trans people did not seek the healthcare they needed due to fear of mistreatment and discrimination.

Conversely, studies have shown that access to gender-affirming care improves health outcomes for trans and nonbinary people. Thus, providing gender-affirming care is necessary to create a healthy and supportive campus environment for all students.

Steps Colleges Can Take to Better Support Trans and Nonbinary Students

Colleges and universities must take firm stances and actions to support trans and nonbinary students, staff, and faculty. They must take concrete steps to support gender-affirming care on campus.

Higher education institutions should not surrender to oppressive legislation. Instead, they should actionably demonstrate their commitments to justice and equity.

Prioritize Mental Health Services

The prevalence of trans hostility and antagonism on and off college campuses means that trans and nonbinary students report higher rates of anxiety, depression, sleeplessness, social isolation, and suicidality than their cisgender peers.

Campus mental health providers must be knowledgeable and equipped to serve trans and nonbinary students. Given concerns of discrimination and harassment, campus mental health centers should engage in outreach efforts to ensure trans students will be well cared for.

Support Students' Chosen Names

Being misgendered and deadnamed are some of the most common experiences of microaggressions and trans antagonism that trans and nonbinary students who have already socially transitioned encounter. Whether deliberate or accidental, these instances add to the mental health stressors of trans and nonbinary people and can also endanger them by disclosing their trans status to others.

Campuses can help by having centralized processes to change names and pronouns across campus — IDs, emails, directories, etc. — not tied to legal processes. The legal process can be expensive and inaccessible for many, particularly as some anti-trans bills seek to ban legal documentation of gender marker changes.

Implement Gender-Inclusive Housing Options

Having supportive spaces to return to at the end of the day can make a major positive difference in students' sense of belonging, well-being, and academic efficacy. Gender-inclusive housing aims to do just that by creating an environment where students of any gender can share a living space that affirms their gender identity.

Housing and residential life staff play an important role in ensuring that trans and nonbinary students' experience in residence halls is met with inclusion and support in mind, from application to placement and beyond.

Provide Insurance That Covers Gender-Affirming Healthcare

Health insurance can already be tricky to navigate for many students. Colleges and universities have the power to choose health plan options that cover gender-affirming care, such as:

• Puberty blockers for students under 18
• Speech therapy
• Hair removal through electrolysis or laser treatment
• Chest binders
• Hormone therapy
• Counseling
• Gender-affirming surgery

Campuses can further support trans and nonbinary students by educating staff on how to guide them through selecting insurance and advocate for them when facing coverage denials.

Employ and Promote Qualified Healthcare Providers

Competent and affirming healthcare providers and staff are a must for the well-being of trans and nonbinary students. The 2015 U.S. Trans Survey stated that a third of trans and nonbinary people who met with a provider experienced at least one form of negative treatment, such as harassment or refusal of treatment.

Campuses can allocate resources to establishing clinics that provide gender-affirming care, such as the ones at UCLA, the University of North Carolina at Chapel Hill, Saint Louis University, and the University of Colorado.