Helping Transgender College Students: Lessons From FSU

Pauline Anderson

May 24, 2017

SAN DIEGO — Transgender youth on campus can face enormous challenges, but a unique initiative at Florida State University has gone a long way toward addressing the needs of this vulnerable student group.

Developed by Ludmila De Faria, MD, assistant professor of psychiatry, Florida State University (FSU) College of Medicine in Tallahassee, the program aims to meet the unique needs of this vulnerable population in a bid to protect their mental health and ensure their academic success.

"This is a very high-risk population that faces discrimination at every corner," said Dr. De Faria.  "For them to finally reach college is already a major accomplishment because they've had to fight a lot of odds."

Here at the American Psychiatric Association (APA) 2017 Annual Meeting, Dr De Faria described the FSU program for transgender campus youth.

Exclusion, Discrimination

Mental health is a major issue among transgendered and transitional youth. Half of them have been sexually assaulted during their life. In a recent survey, 42% of respondents said they'd attempted suicide compared with 1.6% in the general population.

But a 2006 study showed that the rate of suicide attempts or suicide ideation dropped from 29.3% to 5.1% when transgendered youth were offered transition-related treatment.

"This is what pushed me to develop a program for them in college," said Dr De Faria.

Transgendered youth face a number of personal barriers (such as stigma, being a minority or an immigrant, or living in a rural area) and structural barriers (such as access to health insurance and provider knowledge and training) to accessing care.

Before the clinic opened, Dr De Faria heard stories of patients who had insurance, had an appointment with an endocrinologist, and had filled out all the proper paperwork but were told "to their face" at the last minute that the practice doesn't treat transgender people.

"This was happening all the time, even when the treatment was not related to transitioning."

It's important for colleges to develop trans-supportive policies that recognize and respect the gender identity of students, and that includes housing, support groups, and healthcare access, said Dr. De Faria.

As it stands, 19% of respondents to a recent survey who identified as transgender or gender-nonconforming while in higher education were refused gender-appropriate housing, and 5% were refused campus housing altogether. In another survey, 20% of respondents described the attitude of campus security officers toward them as "hostile."

Name Change

Dr De Faria stressed the importance of students being allowed to change their legal name and "gender marker" without having to have a letter from a therapist or doctor or having to change other documents.

She called this "the biggest issue" for transgender students. They are "outed on a daily basis when professors are calling the roster in class."

FSU has come a long way in filling the gap in care for transgender students. For example, it has removed discriminatory exclusions in health insurance plans to ensure equal coverage for medically necessary care, said Dr De Faria.

"We negotiate our own healthcare plan so that we can mandate that all students have healthcare when they come."

The policy covers eating disorders, substance abuse, and transgender care, she said. "It pays for everything except reassignment surgery."

Transitioning Clinic

About a year ago, the university established a "transitioning clinic" that coordinates care among psychiatry, primary care, and endocrinology.

Clinic services include initiating hormone treatment, writing prescriptions for hormones and monitoring hormone levels for transitioning students, and identifying and treating psychiatric comorbidities.

Dr De Faria noted that over 90% of transgender students at her clinic have at least one comorbid psychiatric diagnosis, such as anxiety, depression, or attention-deficit/hyperactivity disorder.

But she said the psychological problems these students may have in addition to gender issues are no different from those of other students, although the "context" may be particular to gender dysphoria.

As the designated psychiatrist for the clinic, Dr. De Faria writes letters for transitioning students so they can access hormones, change their name legally, and get gender reassignment surgery.

The college also regularly trains physicians on providing trans-specific healthcare. 

"When we set up the clinic, a lot of providers asked to be excluded from being assigned to work with this population because they felt they didn't have the training," said Dr De Faria.

In addition, the university provides a list of area therapists who can provide care for students transitioning or struggling with their gender identify, offers a support group for transgender students, and has appointed a patient advocate to represent such students.

During a question-and-answer period following the session, Dr De Faria acknowledged that the clinic has had "some pushback" from the community. Some people feel the transgender community is getting "special attention" and that its members are simply "going through a phase" at college.

Several conference delegates wanted information on how to make their practices more accessible and "friendly" for transgender patients.

The job of providers is to provide a safe environment "for transgender students, to make them feel comfortable," and to learn how to ask the right questions and be open to the answers, said Dr De Faria.

Dr De Faria has disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2017 Annual Meeting Rapid Fire Talks: Focus on Gender and Sexuality #1. Presented May 23, 2017

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