UC Santa Barbara’s Student Health Service has set out to expand gender-affirming healthcare in the last five years. The effort is supported by UCSB’s Resource Center for Sexual and Gender Diversity, an on-campus organization that is advocating for adequate medical care for transgender and queer students.
The initiative at Student Health Service (SHS) is spearheaded by a gender-affirming healthcare team led by Angie Magaña, a nurse practitioner and certified nurse midwife with a specialty in gender-affirming medical care.
“The biggest thing that we do is help people with medical transitions because we’re medical care providers,” Magaña said.
SHS provides a list of gender-affirming care services, including hormone therapy — with prescriptions of testosterone or estradiol — sexual and reproductive healthcare, physical health assessment and treatment, nutritional counseling, social work services, mental health and specialist referrals and injectable medication training and support, among others.
The expansion was instigated in 2017 following student activism around the inadequacy of gender-affirming care at SHS at the time, according to UCSB Public Relations Manager Kiki Reyes and Magaña. Magaña was employed in 2019 in response to one of the demands given to SHS to recruit and hire a professional with a specialty in gender-affirming care.
“I’m always constantly impressed by students and what student activism can actually do,” Magaña said. “It makes such a huge difference in our campus and the way we do things absolutely affects some of the other UC campuses.”
An increasing number of students are utilizing gender-affirming care at SHS, with 19 students with a gender dysphoria diagnosis accessing care in 2017 and 94 students with a gender dysphoria diagnosis accessing care in the current academic year so far.
“Somebody might say, ‘there’s 26,000 students enrolled so that’s a really small percentage,’” Magaña said in reference to the numbers. “But, if we can take care of the least of us, then we got everybody else covered.”
To navigate the array of resources and services available to those experiencing gender dysphoria, SHS has social workers personally consult UCSB clients on what care option is best for them, assess their insurance and indicate what services are available to them.
The center doesn’t offer operational surgeries because medical procedures of that nature must be done in a hospital setting. SHS also doesn’t offer vocal therapy because they don’t have a vocal coach employed. These treatments are initiated through external referrals to surgeons and medical centers in California, primarily in the Bay Area and Los Angeles.
Under the UC Student Health Insurance Plan, the gender-affirming care team recently expanded its coverage of laser hair removal to anywhere on the body starting in the 2022-23 academic year. Magaña emphasized the significance of this expansion, saying that it can often resolve gender dysphoric sentiments for clients who have unwanted hair in other areas of their bodies.
“If you have hair on your hands, it’s pretty hard to shave your hands … So, it’s very difficult to modify yourself,” Magaña said. “This is a very strong signifier of gender in our society so we were really happy to see that change.”
SHS achieved this progress in gender-affirming care partly due to monthly meetings with the Resource Center for Sexual and Gender Diversity (RCSGD), where they discuss the staffing and services of the gender-affirming care team at SHS, possible changes in focus and other feedback on the center’s current operations.
“[RCSGD] has their finger on the pulse of what’s going on with all sexual- [and] gender-minority students,” Magaña said.
Magaña said these monthly meetings are helpful to SHS, giving the center the chance to assess the entirety of the campus community and its needs in regard to gender-affirming care, which is not an opportunity the team often gets.
“We might not be seeing everybody because we’re seeing people who are utilizing medical care, and lots of people — specifically people who identify as nonbinary or gender non-conforming — who might not need hormones to affirm their gender,” Magaña said. “We [want to] understand what the health needs of the campus are and what’s going on and what kind of things [RCSGD] is hearing about. What can we do to support students?”
Such meetings have led to the organization of healthcare panels in collaboration with RCSGD — the most recent of which occurred on Nov. 4 — to educate students on how to access hormone care and other medical services at SHS. The pairing also did presentations on the actual experience of receiving hormone care, bodily autonomy and reproductive healthcare for those on the gender spectrum, among other topics.
“We’ve been able to work really closely with everybody at RCSGD … and we have a relationship such that if [RCSGD] hears something that they feel like needs more immediate attention, we don’t wait,” Magaña said.
As per insurance requirements, patients are mandated to get a diagnosis of gender dysphoria in order to proceed with surgery, which indicates that there is a disparity in one’s perceived gender and assigned sex at birth, according to Magaña.
Qualifying for a surgical procedure also requires a letter of mental health readiness, which is issued by UCSB’s Counseling & Psychological Services (C.A.P.S.) in collaboration with SHS. If the surgery involves reproductive organs, a client is required to obtain two of these letters from two different professionals in C.A.P.S.
Magaña said that the center does provide consultation and a space after the surgery for questions on aftercare and general surgical follow-ups.
Vocal therapy does not require a letter from a mental health professional, but it does require a referral. The coaching itself is often done in the Bay Area, according to Magaña. This process looks similar to laser hair removal as well, which is based on referrals and is operated by local providers that are in the network of SHS.
Looking forward, the gender-affirming care team hopes to increase training for the SHS staff on topics like correct pronoun usage and expand on its current services in accordance with World Professional Association of Transgender Health guidelines — which recently released a new set of guidelines that SHS is currently working to implement.
“The more we can lead by example and make sure that we’re practicing evidence-based care and giving our students the best care, the better it is for everybody,” Magaña said.
On RCSGD’s end, the organization is looking to hire a new Health Equity Advocate, a currently vacant position that has existed for about five years and acts as a liaison between RCSGD and SHS to ensure equitable access to healthcare at UCSB for transgender, queer and intersex people, according to Buchanan.
“In the future, the person will act as the primary first contact for any students that are having trouble accessing healthcare, especially trans students who want to talk about options or ask questions or need help with health insurance access,” Buchanan said.
Buchanan emphasized that having adequate access to gender-affirming care at UCSB is invaluable, saying that for many college students, this is the phase of their life where they need resources and services to explore their genders apart from family and home.
“This is a huge step of a lot of queer and trans people away from a home that might not be very gender-affirming or supportive,” he said. “I know that coming here was my first chance to get away from what I was experiencing at home and, once I got here, I was finally able to pursue transitioning because my parents were not going to help me do that when I was not an adult.”
Magaña said that in a university with a wide student demographic, addressing concerns of gender dysphoria through medical services and cultivating a community of support in any student’s gender journey is what the team stands for.
“Without gender-affirming care, there’s increased rates of depression and self-harm,” Magaña said. “Dysphoria is real … and we have the support to make a really special community where being who you are in your gender is a safe and celebrated thing to do.”
A version of this article appeared on p. 4 of the Nov. 17, 2022, print edition of the Daily Nexus.