It took three months for environmental management and protection senior Autumn Ford, who identifies as transfemme non-binary, to see a physician who could prescribe her the hormones she needed to be herself.
Until then, she was in a constant battle with gender dysphoria, feeling as though she was not in the right body.
“It wasn’t like the movies’ switch, like ‘Oh no what am I going to do?’” Ford said. “It was, it was like almost an existential horror.”
Gender dysphoria can come in many different forms, Queer Community Action, Research, Education, & Support (QCARES) lead and psychology professor Jay Bettergarcia said. But, at its core, Bettergarcia said gender dysphoria is any time a person is uncomfortable with the parts of themselves that are gendered, because they are in misalignment with their identity – whether that be the way their voice sounds, their physical appearance or how they are perceived by others.
Ford was a sophomore when she came out as transgender non-binary and decided to begin her physical transition with hormone replacement therapy (HRT).
She went to the Cal Poly Health Center hoping to begin HRT. However, she was referred to an off-campus physician because the Health Center did not offer HRT – until now.
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At the beginning of Fall 2019, the Health Center began offering HRT and formed a gender-affirming care team. The team consists of Dr. Jennifer Bobell and Dr. Kimberli Andridge, Assistant Vice President for Student Affairs and full-time psychiatrist Elisa Feingold, according to a Cal Poly news release.
Bobell said the “soft launch” of the new services began week one, but they chose to focus on setting up and improving their services before making an official announcement.
Bobell said she had been interested in transgender care for a while and began asking about providing HRT about a year ago when Dr. Denise Taylor, who used to be the sole provider of HRT in San Luis Obispo County, and Ford came in to talk about LGBTQ+ needs.
“Its something that’s so so vital to people like me to have a discreet place where we can get our care.”
With the help of assistant vice president for Student Affairs Health and Wellbeing Tina Hadaway-Mellis and Pride Center Coordinator Samuel Byrd, the team came together to asses LGBTQ+ health care needs.
“Even if it’s one student on this campus [who] identifies as a trans person or genderqueer or gender-nonconforming or nonbinary, that student has paid the health fee, that student has access to our services,” Hadaway-Mellis said. “Those services should be inclusive of their needs as well.”Invalid slider id. Master Slider ID must be a valid number.
As of September, the Health Center offers estrogen for feminization and testosterone for masculinization, as well as spironolactone, which Bobell said is often taken for feminization too.
“At this point, I haven’t had anyone coming who was already on hormone therapy or coming in new who was on anything else than those three,” Bobell said. “But I’m open to discussing with any of the patients at any time anything that they’ve read about, any questions they have and looking at the research that is available.”
The costs of hormones at the Health Center for students range from $8 to $30 a month, depending on the dosage of hormones and the method – pills or injections. Consultations with doctors are covered in student health fees.
Byrd and Hadaway-Mellis said providing HRT is the first of about 16 action items in the works to improve LGBTQ+ health care at Cal Poly. One service that will be added to the Health Center is an LGBTQ+ Mustangs in Recovery group for members of the LGBTQ+ community who are recovering from drug and alcohol abuse.
Hadaway-Mellis and Byrd worked at UC Berkeley — which Byrd said is a leader in LGBTQ+ healthcare services for college students — before they both began working at Cal Poly in June 2018.
“I think a lot of my experience [at UC Berkeley] has informed and encouraged some of the direction that we’ve headed in, and so this has really been a seed in my mind, and I know it’s been a seed in Sam’s as well, probably since we arrived,” Hadaway-Mellis said.
The University of California System offers HRT at a number of its campuses, and Byrd said UC Berkeley has phenomenal LGBTQ+ care, which was not the case when they arrived in San Luis Obispo.
A 2019 San Luis Obispo County LGBTQ+ needs assessment conducted by QCARES found approximately 85 percent of transgender and nonbinary individuals admitted to having thoughts of suicide, and 68 percent of those surveyed reported not being able to find an LGBTQ+ competent provider. A competent provider means someone who has knowledge, awareness and skills about LGBTQ+ care, according to Bettergarcia, who lead the survey.
“The experiences of queer and trans people in this county are strikingly different than other places in California,” Byrd said. “Almost on all the different levels we see higher rates of suicide, higher rates of attempted suicide.”
The “staggering” results of the QCARES study, Byrd’s assessment of Cal Poly’s LGBTQ+ services and the Cal Poly Experience Survey results all provide data that helped to quickly get the ball rolling at the Health Center.
Hadaway-Mellis said Cal Poly has offered aspects of gender-affirming care through mental health services, for many years. However, prior to this school year, California State University (CSU) campuses did not offer HRT, according to CSU Spokesperson Elizabeth Chapin in May 2019.
Currently, Cal Poly, San Jose State and Chico State offer HRT, according to Hadaway-Mellis.
“Right now a handful of [health centers are] independently moving in the direction that is more inclusive,” Hadaway-Mellis said. “There is a definite interest and commitment for all of the centers to move in this direction.”
Chapin told Mustang News in May that HRT did not fall under Executive Order 943, which governs the 23 CSU health centers. However, Hadaway-Mellis said the order does not define basic needs or state that HRT cannot be provided as such.
“[The executive order] has no language related to gender affirming care for trans students or providing care to trans students,” Hadway-Mellis said. “It talks about basic primary care … so as health center directors through the CSU, we’re having conversations about what this means and how we define basic care, basic primary care.”
Executive Order 943 states that health centers are meant to facilitate student retention and enhance student’s academic performance by providing accessible and high quality basic medical care.
“[HRT] is primary care,” Byrd said. “It’s not specialty care, and some voices in the community will like to say ‘oh, that’s specialty care.’ This is allowing people to feel comfortable in their skin and allowing them to navigate our community. That’s primary.”
Although Ford still receives her hormones from an off-campus provider, she said accessibility to such care at Cal Poly is necessary.
“Its something that’s so so vital to people like me to have a discreet place where we can get our care, and we don’t have to worry about it being the rug ripped out from under us or taken away from us and we can just continue being,” Ford said. “Having the space on campus now where people could get their care is really amazing.”