Trans* Health

Note on the terminology used on this page: For this page, we use the term “trans*” to refer to those who express their gender differently than how society expects them to based on the sexual anatomy they were born with. This encompasses a range of gender variant identities including, but not limited to, transgender, genderqueer, transsexual, FTM (female to male), or MTF (male to female). When we talk about more specific health issues, we will use the terms FTM and MTF. We recognize that these labels may not be used by all trans* people, and we acknowledge that gender identity is far more complex than these two terms.

Trans* students at Brown often have health concerns that other students may not. This page is meant to provide guidance for students who identify as trans* so you can take steps to be in control of your health. Because there is a range of gender variant identities and experiences, not all of the topics presented below may be relevant for you.

What are the major health issues facing trans* students?

If you are trans*, you may find that you frequently face obstacles that other people may not ever encounter. When at college, you may worry about what bathrooms to use, what housing to apply for, finding quality health care, and how your roommates, professors, or friends may react if you tell them you are transgender. You may also worry about and experience discrimination and violence.Transphobia can sometimes lead to mental health concerns, such as depression, anxiety and risk of suicide. Because of all these concerns, this page will offer you links to resources that can offer you support and care and information to help you navigate your time at Brown.

Brown is dedicated to providing an environment that creates safety and wellness for transgender students. The LGBTQ Center can offer support for gender exploration and during social or physical transition. The Office of Residential Life works to provide housing accommodations that best meet the needs of transgender students. Both Health Services and Psychological Services strive to provide trans-sensitive care to students. Whenever possible, they will also assist you in finding other medical professionals who can help you obtain the emotional and physical care specific to your needs.

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How do I prepare for a visit to Health Services?

Sometimes you might feel uncomfortable seeking health care because of a fear of transphobia and the concern that you will not receive appropriate and sensitive care. This can make it harder to seek health care when you need it. At Health Services we strive to be a safe space for trans* students to seek appropriate, sensitive, non-discriminatory health care. If you are a Brown student with feedback about how we can improve our services, please contact Lynn_Dupont@brown.edu.

On a visit to Health Services you can expect to receive care that is sensitive to you as a trans* person and responsive to health care concerns you might have. Questions about your health behaviors and sexual activity are not intended to stereotype you and are not based on assumptions about how you behave. Rather, they're a standard part of care at Health Services. A good medical provider will ask questions about your health behavior in a sensitive way, not making any assumptions, but assessing your level of risk. However, if you ever don't feel comfortable answering a question, just say so. Remember that your visits to Health Services are covered by medical confidentiality laws.

You play an integral part in the health care you receive. Communicating openly and honestly with your medical provider is an important way to receive comprehensive and sensitive medical care. This includes talking about issues like sex and gender. It's also important that you feel like you can ask questions of your provider. We suggest that you find a provider at Health Services that you feel comfortable with to take the lead on your medical care. While all providers are available to you, this person will come to know your history well and, by building a relationship with this provider, you can optimize your health care and feel safer discussing your concerns and issues. Ask around about which providers your friends use or make a point of meeting different providers when you schedule appointments.

One way to approach a trip to Health Services if you're nervous is to do some research before you come in. Think about and read about any specific health concerns you may have. See the health concerns list below for specifics that you might not have thought about. If you have questions for your provider, write them down and bring them in -- sometimes it's hard to remember all of your questions once you're in the exam room. Remember that you can tell your provider that you are nervous and they can help you through the questions.

Finally, patient comments are very important to us. If you have any feedback about our services, good or bad, please fill out a patient comment form and put it in the boxes that are in the waiting rooms. We address all complaints, and the more specific you are, the better we will be able to fix the problem. If you choose to leave your name, we will follow up with you. You can also contact Lynn_Dupont@brown.edu. Lynn is the Associate Director of Health Services and she follows up on all student feedback.

Health Services is located at 13 Brown Street on the corner of Brown and Charlesfield Streets. Brown student can call 401.863-3953 to make an appointment.

What steps is Health Services taking to become more welcoming to trans* students?

Working with a consultant who is also a Brown alum, Health Services has undertaken a number of initiatives to be more welcoming and to improve our care for trans students. This ongoing work includes:

  1. Training for medical providers.
  2. The identification of specific medical providers who are working on developing expertise in trans health issues and who have expressed a particular interest in working with trans students.
  3. Training for medical assistants and schedulers.
  4. A comprehensive review of our services, including paperwork, signs and posters in the building, and the Health Services and Health Education websites, to identify areas for improvement.

Throughout this ongoing learning process, we welcome trans* students to utilize our services and we would be grateful for any feedback you can offer us. If you have any concerns or questions about care at Health Services, please contact Lynn_Dupont@brown.edu. Lynn is the Associate Director of Health Services and she follows up on all student feedback.

Are there specific providers I can request at Health Services?

Students are welcome to make appointments with any provider at Health Services. In addition, some of our medical providers are working on developing particular expertise in the area of trans* health care. You can request any of these providers by name when you call to make an appointment:

  • Cindy Capra, Nurse Practitioner
  • Patricia Maier, Physician
  • Marsha Miller, Physician
  • Laura Ward, Nurse Practitioner

Click here to see their pictures and learn about their backgrounds. Again, these providers are currently pursuing training in this area. Throughout this ongoing learning process, we welcome trans* students to utilize our services and we would be grateful for any feedback you can offer us. If you have any concerns or questions about care at Health Services, please contact Lynn_Dupont@brown.edu. Lynn is the Associate Director of Health Services and she follows up on all student feedback.

Is my visit to Health Services confidential?

Yes. All visits to Health Services are confidential. In addition, the staff at Health Services is accustomed to working with students who are concerned about confidentiality issues related to insurance billing (this is a common concern for students who are on their parents’ insurance plans) and we can work with you to negotiate this issue as well.

Visits to Health Services providers are covered by the Health Services fee paid by all students. There is no office visit charge. Lab charges and prescriptions are not covered by the fee. These charges can be billed to insurance or paid for out of pocket.  Individual insurance coverage will vary, but Health Services will help you understand the insurance billing process.

Are hormones available at Health Services?

To begin using hormones, Health Services would refer you to a specialist in hormone therapy.  Once the specialist prescribes hormones, Health Services’ providers can work with you and the specialist to have your prescriptions filled here at Health Services.  As mentioned above, we will work with you regarding the insurance billing process.

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Are trans students at risk for STIs?

The risk for sexually transmitted infections (STIs) depends on your specific sexual behaviors. You can protect yourself and your partner(s) from STIs by using condoms and/or dental dams each time you have sex, by cleaning sex toys properly, and by seeking STI testing and treatment as needed. Visit our sexual health pages for more information on STIs, safer sex and sexual communication.

What does it mean if a trans student “transitions”?

Deciding whether or not to “transition” can be a complicated choice. Some students decide to transition socially, meaning they change their name, use different pronouns, wear clothes and use mannerisms associated with a different gender. Some students may choose to transition medically as well. This may include hormone therapy and chest or genital reconstruction surgeries. Most often, a surgeon performing these operations will require a letter from a psychologist, who is working under the Harry Benjamin Standards of Care stating that the patient is psychologically ready for any body modification surgeries. Although the trans* community is growing and becoming more visible, research and literature on trans* health remains sparse. It is important to discuss health risks with a medical provider when contemplating any physical changes.

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What are the health concerns for FTM students?

Gynecological and breast health

  • Sometimes, FTM persons dissociate from their breasts and genitals. This can cause physical or emotional discomfort. Additionally, you may find it is difficult to find a medical provider who is sensitive to your needs. Because of these barriers, FTM patients are less likely to receive the regular medical exams--including GYN exams and breast exams--which are important to maintain a healthy body and detect cancers, STIs, or other illnesses.
  • If you bind your chest, make sure that the material used to bind can wick away sweat. If not, sores and other skin irritations can occur. If the binding is too tight it may hurt, cause cuts, irritate the skin, or prevent comfortable breathing.
  • If you have had a mastectomy, you should consult with your medical provider about whether or not to continue breast exams, as some breast tissue may still be present.
  • Unless you have had a hysterectomy, regular GYN exams and pap smears remain an important piece of your total health care.

Hormones

  • FTM people may choose to use testosterone (“T”) to create changes to your body, including lowered voice, redistributed body fat, increased muscle and hair growth, and enlarged clitoris.
  • For some, this choice is made easily, while others will struggle with the idea and may go on and off testosterone at different points in their lives. When considering testosterone, it is important to visit a medical provider for a physical exam and regular updates on blood work and health status. Various personal and family health factors will influence how each person will react to use.
  • It is also important to obtain testosterone through a medical provider. Using testosterone that is bought off the “black market” is illegal and unsafe. It may limit your access to clean needles (some states require a prescription to buy and carry needles; Rhode Island does not), and it can be impure (cut with other substances). It also critical to use the appropriate dosage as determined by a medical provider. Taking more testosterone than prescribed will not speed up the changes desired and may increase the risk of serious side effects.
  • Possible health effects of testosterone use include acne, balding, increased fat around the abdomen, high blood pressure, high cholesterol, and liver problems. Medical research has not yet determined the long-term effects of using testosterone.
  • It is still possible to become pregnant while on testosterone, although infertility occurs after continued use. Speak to your medical provider for more information about fertility and contraception options if pregnancy is a concern. Some FTM people choose to have their eggs frozen before starting testosterone, to have the option of using them later, either by giving birth themselves or by using a surrogate.

Surgery

  • If you decide to have surgery as part of a transition from female to male, surgery options can include liposuction, breast reduction, double mastectomy, or pectoral implants (“top surgery") and various “lower surgeries” including testicular, metoidioplasty (clitoral hood release), phalloplasty (construction of a penis), and hysterectomy (removal of the uterus).
  • As with any surgery, there can be minor or major complications during and after these procedures. It is important to follow the guidelines given by your surgeon and medical provider at all times. These surgeries are expensive, and may also require time off from school or work. Not everyone will be a candidate due to other medical conditions. Most surgeons in the US will also require a clearance letter from a psychologist, in compliance with the Harry Benjamin Standards of Care.

What are the health concerns for MTF students?

Hormones

  • If you are transitioning from male to female you may choose to use estrogen to create changes in your body like softer skin, smaller muscles, redistributed body fat, and breast development. For some, this choice is made easily, while others will struggle with the idea. If you are considering estrogen therapy it is important to visit a medical provider for a physical exam and regular updates on blood work and health status. Everybody reacts differently to estrogen therapy and various personal and family health factors will influence how your body reacts to it.
  • It is important to only use estrogen obtained through a prescription. Using estrogen that is bought off the “black market” is illegal and unsafe. It may limit your access to clean needles (some states require a prescription to buy and carry needles; Rhode Island does not), and it can be impure (cut with other substances). It also critical to use the appropriate dosage as determined by a medical provider. Taking more estrogen than prescribed will not speed up the changes desired and may increase the risk of serious side effects. Regular breast self exams (BSE) should be performed once breast tissue growth occurs.
  • Side effects of taking estrogen can include weight gain, reduced libido, loss of the ability to achieve an erection, decrease in penile size, and reduction of sperm count. Other common side effects include mood swings, altered perceptions, and changing hunger patterns.
  • Smoking while using estrogen therapy increases the risk for blood clots, which can lead to heart attacks, strokes, or other permanent damage.
  • Although there may be a reduction in sperm count when taking estrogen, it is still possible to get someone pregnant, especially during the first year of estrogen use. Some MTFs choose to have their sperm frozen prior to starting hormone therapy, in order to have it available for later use.

Silicone and Oil Injections

It is dangerous to inject silicone or oils in order to add to your cheekbones, lips, thighs, breasts, hips, buttocks, etc. Silicone is toxic to the body and can lead to serious health risks, such as pain, swelling, blistering of the skin, and disfigurement. The FDA has never approved silicone injections for sale for human use. For more information, check out “Silicone Use: Illicit, Disfiguring, Dangerous.”

Surgeries

  • Some MTFs decide to have reconstructive surgery or electrolysis for hair removal.
  • If you decide to have surgery as part of a transition from male to female, some surgery options are breast augmentation, tracheal shave, orchiectomy (removal of testicals), and vaginoplasty (creation of a vagina).
  • If, as part of a vaginoplasty, tissue from the penis is used to create a neo-cervix, you should ask your provider about beginning to get regular GYN screenings, including Pap smears.
  • If you have orchiectomy surgery (removal of the testicles), bone density screenings, following guidelines for biological females, arerecommended.
  • As with any surgery, there can be minor or major complications during and after these procedures. It's important to follow the guidelines given by the surgeon and medical provider at all times. These surgeries are expensive, and may require time off from school or work. Not everyone will be a candidate due to other medical conditions. Most respected surgeons in the US will also require a clearance letter from a psychologist, in compliance with the Harry Benjamin Standards of Care.

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How can I support my trans* friend or family member?

Family members and friends of trans* students may experience stages of denial, confusion, and grief, along with concerns about safety. Here are a few things that you can do to show support for the trans person in your life:

  • Learn more about what trans* means. Read books and websites by or about trans people. Attend workshop or conferences on LGBTQ issues.
  • Talk to the trans*person in your life. Find out what name and pronoun they prefer and ask how they would like you to support them.
  • Take time to think about what you know about trans* people, what your assumptions are, what things might be hard for you, and what questions you may have.
  • Get support for yourself, such as individual or group counseling and attend support groups.
  • Speak out against anti-trans* behavior. Let people know you don’t want to hear offensive slang, stereotypical remarks, or put downs about trans* people. Share your knowledge and experiences with those around you.

There are many resources, both locally and nationally, that offer support services for friends and family members of trans* people. Parents, Families & Friends of Lesbians & Gays (PFLAG) promotes the health and well-being of gay, lesbian, bisexual and trans* persons, and their families and friends through support, education, and advocacy, to end discrimination and to secure equal civil rights. On campus you can contact the LGBTQ Resource Center (401.863-3062), Health Education (863-2794), and Psychological Services (863-3476).  The Queer Alliance (a student group) is another important on-campus resource.

Is intersex the same as transgender?

No, an intersex person is someone born with reproductive organs that are neither exclusively male nor female. Approximately 1 in 2000 people are born with ambiguous genitalia. However, some people do not find out they have intersex anatomy until puberty. Sometimes parents will decide to have genital surgery performed on an intersex baby. The decision to perform surgery on a baby is a highly debated topic. Some people feel that performing the surgery allows for better psychological health. Others believe that there’s virtually no evidence that people with “uncorrected” intersex genitals suffer increased rates of psychological illness, and that more distress can be created for people who have had the surgery. You can visit the Intersex Society of North America for more information on support resources.

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Campus resources

Brown LGBTQ Center 401.863-6062          
The LGBTQ Center is a safe space for all students, staff, and faculty dealing with questions of sexual orientation and gender identity. The Center offers confidential support, information, and referrals for LGBTQ individuals and the people in their lives. Additionally, it offers fellowship advising and assistance with academic projects, as well as educational workshops.

Health Education 401.863-2794
Health Education is available for individual appointments and group education on a variety of health issues, including LGBTQ health, alcohol, other drugs, nutrition and safer sex. We have condoms, lube, and dental dams available at rock-bottom prices. Come visit us, we are located on the 3rd floor of Health Services.

Health Services 401.863-3593 
Health Services provides a range of services including general health care, STI testing, and emergency medical care. You can request a specific medical provider by name or by gender. We are located at 13 Brown Street on the corner of Brown and Charlesfield Streets. Brown students can call 401.863-3953 to make an appointment.

Psychological Services 401.863-3476
Psychological Services provides assessment, brief psychotherapy, and crisis intervention for Brown students.

Chaplain's Office 401.863-2344
The Chaplains are available for personal counseling about religious and social issues, parental and peer difficulties, career choices, interpersonal relationships and sexuality. A number of programs are offered during the year that include ecumenical discussion groups, innovative worship experience, ecumenical services, and dramatic and artistic events.

Queer Alliance
The Queer Alliance serves as an umbrella organization for a number of groups on campus. Its mission is to be a multifaceted service to the LGBT community by offering resources through subgroups, community discussions, and events. The LGBTQ Resource Center (Faunce House, Room 321) has a wide array of queer-related books, movies, literature and resources. You can e-mail queer@brown.edu for more information or to get involved.

Links you can use

Vancouver Transgender Health Program
Information on hormones, surgery, and voice changes plus guides for trans patients on health issues including body image and weight, cancer, vaccinations, diabetes, osteoperosis, and cardiovascular disease. This site also has clinical protocols for trans health care.

Youth Pride, Inc. 401.421-5626
Youth Pride, Inc. (YPI) is Rhode Island’s only statewide nonprofit organization with programming dedicated to meeting the social, emotional, and educational needs of youth and young adults impacted by sexual orientation and gender identity. The drop-in center offers support services, social activities, and outreach opportunities for youth ages 13-23.

TGI Network of RI
TGI Network of Rhode Island is a statewide organization serving the needs of the transgender, gender-variant, and intersex (TGI) communities in Rhode Island and surrounding areas through support, advocacy, and education.

Trans-Health
An online magazine of health and fitness for transsexual and transgendered people, consisting of articles written by people from around the world.

Gender Education and Advocacy  
Offers online resources focusing on the needs, issues, and concerns of gender variant people in society.

The Intersex Society of North America
A website offering resources for people seeking information and advice about atypical reproductive anatomies and sex development disorders.

The GLBT Health Access Project
Offers resources, materials, and trainings designed to improve the quality of health care provided to LGBTQ people.

PFLAG Parents and Friends of Lesbian and Gays
PFLAG promotes the health and well-being of gay, lesbian, bisexual and transgender persons, their families and friends through support, education, and advocacy.

Trans Academics
A place where people of all genders can discuss gender theory, the trans community and its various identities, both as a part of the academic world and day-to-day life.

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Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.