A guide for transgender and gender non-conforming students
This is an accordion element with a series of buttons that open and close related content panels.
I want to begin hormones for gender affirmation. I’m clear about my decision and want to begin medical transition.
UHS offers hormone replacement therapy (HRT) in an informed consent model. UHS does not require a student to get a letter from a mental health provider in support of hormones as long as they can provide informed consent for care. A student can provide informed consent if they:
- Have correct information about HRT
- Are able to understand the HRT information provided includes risks and benefits, as well as reversible and irreversible effects
- Are able to use this information to make a decision**
The informed consent model is consistent with WPATH Standards of Care and reduces barriers to accessing medically necessary treatment. In this model, students are given accurate and comprehensive information about HRT, and will be supported in making the right decision for them. Providing care in an informed consent model does not mean that hormones are available on demand. If a medical provider determines that a student seems unable to provide informed consent, a student may be referred to Mental Health Services for further evaluation. An example of when a student may not be able to provide informed consent is if they experience acute psychosis related to gender.
Five UHS medical providers are trained to provide care related to gender affirming hormones, including initiation and maintenance. In addition to medical training involving case studies, the providers participated in a 12-hour training facilitated by UW–Madison’s Gender and Sexuality Campus Center. Providers who offer care HRT-related are:
**language from Howard Brown Health
I want to begin the process to start hormones.
- Book an initial Trans Health appointment on MyUHS. Or call the Primary Care Clinic at 608-265-5600 (option 1). Ask to schedule an appointment to begin hormones.
- You and your provider will create a care plan, discuss your medical goals, provide informed consent, and complete labs as directed.
- Attend a follow-up medical appointment with your provider where you will review labs results, discuss potential medical contraindications, and, if appropriate, receive a prescription for HRT.
Ongoing work with you medical provider and follow-up care will continue. Follow up appointments are routinely scheduled at one, three, six, and 12 months.
UHS understands that stress related to discrimination impacts your well-being and can exacerbate anxious and depressive symptoms. If you experience distress, we encourage you to talk with your medical provider to learn about options for gaining additional support. UHS offers individual and group counseling with providers who have extensive experience working with TGNC students, can prescribe psychotropic medication if appropriate, and has many wellness and stress reduction offerings.
Transitions can be stressful and having support will be important. In addition to what is offered at UHS, students also have access to many community-based supports including discussion and peer facilitated support groups offered by the Gender and Sexuality Campus Center and OutReach LGBT Community Center.
I need a letter for surgery.
UHS follows the WPATH SOC v 7 recommended guidelines for letters in support of surgery. Surgeons who follow WPATH standards require one letter from a mental health provider in support of top surgery and two letters from two different mental health providers in support of bottom surgery. For some surgeries, you may need to undergo permanent hair removal processes for more than six months and be on HRT for more than one year.
To meet with a Mental Health Services provider to talk about getting a letter in support of surgery, schedule an Access Appointment. During your consultation, tell the Access Specialist that you would like to be scheduled for a gender identity consultation for a surgical letter.
During your appointment, your mental health provider will conduct a psychosocial assessment to gather information needed for the letter of support as required by surgeons and insurance providers. Letters of support typically include information about mental health treatment:
- Summary of the psychosocial assessment, including diagnoses that are relevant.
- Information about how long you have worked with your mental health provider and the type of evaluation and counseling you’ve participated in
- An explanation that the rationale for surgery has been met, and a brief description of the clinical rationale for supporting your request for surgery
- A statement about your ability to provide informed consent for surgery
- A statement inviting the surgeon to contact your mental health provider/s for coordination of care
Many bottom surgeries require a lengthy recovery period and may require numerous procedures, and it is not uncommon for complications to occur. Our mental health providers will work with you to help build and support your resilience in preparing for any post-surgical needs you may have.
I want to talk to a mental health provider who has training/experience working with TGNC clients.
We understand why many TGNC students want to work with mental health providers who have experience and training in gender identity and expression. Whether you want support in your exploration of gender identity, you experience symptoms of anxiety or depression, or have other concerns; Mental Health Services has providers who offer care in an affirming way.
Many of our mental health providers have participated in at least one 12-hour gender identity training facilitated by the UW–Madison Gender and Sexuality Campus Center. This training included: information about campus climate for TGNC students; language commonly used to by trans, gender non-conforming, and gender expansive students to talk about identity; information about bias and the impact of discrimination on wellness; strategies to support students in their exploration of gender identity and expression; and training in writing letters of support for HRT and gender affirming surgery.
UHS has providers with a designated focus and in-depth experience working with TGNC students & LGBTQ students.
To meet with a UHS mental health provider, schedule an Access Appointment. During this consultation, tell the access specialist that you would like to receive care from a provider who has experience with TGNC students. You may also request to work with a LGBTQ- or TGNC-identified mental health provider.
I identify as TGNC and would like to participate in a support group or learn about community resources.
There are a number of campus and community-based support options for TGNC students.
The Gender & Sexuality Campus Center has a TGQ page with information about discussion groups and other resources. Gender Explorers is a peer-facilitated, open discussion group that is a space for participating who identify across the gender identity/expression and trans spectrums to come together and explore concepts of gender in their own lives. This group is open to all members of UW–Madison.
UHS Mental Health Services facilitates a weekly TGNC Support & Empowerment group during the fall and spring semesters. Additional group offerings include weekly LGBTQIA Support & Empowerment groups. Mental health providers facilitate these counseling groups. If you are interested in participating in a group, visit our Group Counseling page to learn more.
If you are interested in groups not affiliated with UW–Madison, visit OutReach LGBT Community Center to learn about other options and resources. OutReach hosts groups including an FTM/Genderqueer group and the Madison Area Transgender Association (MATA) social/support group.
I need a doctor’s note to change my name/gender markers on identity documents but haven’t seen a UHS provider for my gender care.
Certain identity documents require a physician letter to certify a change in gender or name. If your previous HRT provider is not able to provide documentation, UHS can this provide for no cost for registered students.* You will need to establish care with a primary care provider who provides HRT. The provider will need information regarding your “transition-related treatment.”** Usually one to two office visits and a review of outside medical records from your past HRT-provider will satisfy this requirement.
Outside medical records can typically be obtained at no cost when they are transferred directly to UHS. You can start this process online prior to your first appointment:
- Log into the “MyUHS” portal on our website
2. Click on “Messages” on the left-hand side
3. Click of “New Message”
4. Check “I am a UW student or domestic partner”
5. Check “I want to authorize RELEASE OF MY HEALTH INFORMATION”
6. Complete the remainder of the form, electronically “sign” the form and click “Send”
*If you are not registered for classes over summer break, you will need to pay the one-time summer fee to access UHS care and services during the summer.
** Wording per the Transequality website’s nationwide database for identity documents:
See https://transequality.org/documents for details.
I receive HRT from UHS and need a doctor’s note to change my name/gender markers on identity documents.
You can schedule a follow-up appointment or log in to your MyUHS account and send a new message directly to your current HRT provider. Tell your provider what type of document and what state (if applicable) you need.
Completed letters are signed, placed in sealed envelopes, labeled with your name in use and date of birth, and available for pick up with a 5th floor receptionist during business hours (your provider will specify the specific desk when they message you to let you know the letter(s) are ready). Signed letters can be scanned into the medical record and shared electronically in your MyUHS account. Some students use this option if they are off campus.
If you face a deadline to complete a letter, schedule a visit with the next available HRT provider. They can review your records and typically create the required letter(s).
Please note some letters require a doctor’s signature. If you see a physician’s assistant or nurse practitioner for your HRT, they will consult one of the licensed physicians who provide HRT to review your medical records and co-sign the documents.
Informed consent for hormone replacement therapy
University Health Services uses what is known as an informed consent model for care related to hormone replacement therapy (HRT). Informed consent is an evidence-based model of providing care that is used in healthcare agencies serving and run primarily by LGBTQ+ and Transgender and Gender Non-Conforming (TGNC) communities.
UHS began offering HRT for students in 2013, with the requirement that students first meet with a mental health provider to complete an assessment to receive a letter in support of this care. The requirement to meet with a mental health provider increases stigma for a community that has disproportionate healthcare disparities, and this requirement sends the message that TGNC people do not understand themselves, their needs, or their own experiences. Informed consent removes the requirement of meeting with a mental health provider prior to being able to access medical care, thereby making the process of beginning HRT consistent with the process for starting other medications.
UHS providers understand that oppression and marginalization have significant links to healthcare disparities, and in making this change, UHS moves toward eliminating disparities in the delivery of our care.
UHS’s collaboration with Gender and Sexuality Campus Center is an example of how services can change and adapt to better meet the needs of individuals who are members of historically underrepresented communities. By listening to these communities, following their lead, honoring strategies used within these communities, collaborating, working to understand the impact of oppression on healthcare disparities, and actively working to eliminate bias in our delivery of healthcare, we hope to create healthcare homes for students who may not have previously felt welcomed or cared for.
Transition can be stressful and having support will be important. Mental Health Services offers individual counseling, meetings to support students considering gender affirming surgeries, and weekly support and empowerment groups. Providers who have advanced training and experience working with TGNC students are available.