During her sophomore year at Cal Poly, environmental management and protection junior Autumn Ford came out as transgender non-binary and was ready to begin her physical transition with Hormone Replacement Therapy (HRT).

“I had known from a fairly moderate age that I wanted to be seen as androgynous, and I hated my body,” Ford said. “Everything about it was wrong. My voice was wrong, my hair was wrong, my skin was wrong. Everything was just wrong.”

Ford scheduled an appointment with the Health Center’s Counseling Services and said she expected a campus physician to write an HRT prescription. HRT can be taken in the form of a pill, injection or gel and significantly changes certain physical features. Instead, she was referred off-campus and waited more than three months to begin treatment. She also was responsible for treatment payment, whereas most on-campus health services are free or at a lower cost. 

The California State University (CSU) system, including Cal Poly, does not provide HRT in any of its 23 health centers across the state, according to CSU spokesperson Elizabeth Chapin.

According to Chapin, HRT is not considered a basic healthcare service, and it is not included in Executive Order 943. Doctors are not permitted to provide HRT unless it is authorized by CSU administration as an “augmented service,” meaning it must meet six requirements: The service must be provided consistent with CSU policy and in a manner that does not divert resources or staff from the adequate provision of basic student health services, the Health Center or contracted provider is equipped to provide the service and the medical qualification and specializations of the staff must be sufficient to provide the service.

Justification of student need or demand for the service also must be met. The method for providing the service must be the most effective in terms of both treatment and cost, and proposed services have to be submitted for consideration to the student health advisory committee prior to review by the campus president or designee.

Diego Rivera | Mustang News

So when students request HRT, they are referred out to a doctor in the county. For Cal Poly students, that doctor is Denise Taylor.

To her patients, Taylor is in the business of saving lives. With pills and needles, mostly.

Taylor is a correctional health professional at the California Men’s Colony (CMC) four days a week.

But on Thursdays, Taylor writes new prescriptions for HRT.

Taylor is the only doctor in San Luis Obispo County known for writing new prescriptions. She said many of her patients who seek HRT are college students from Cal Poly.

Taylor has met with doctors at the Health Center three times in the past 10 years asking them to offer HRT treatment. She said she felt she had gotten somewhere.

“I don’t think [HRT] would be any different than someone coming in who has diabetes or has to take blood pressure medicine or has to take birth control pills,” Taylor said. “It’s all kind of the same stuff.”

“I don’t think [HRT] would be any different than someone coming in who has diabetes or has to take blood pressure medicine or has to take birth control pills”

Taylor said the treatment is simple — routine lab tests and the hormones are the only required services.

“The medications themselves are quite inexpensive,” Taylor said.

Taylor said estrogen costs approximately $30 monthly. Ford said the doctor’s appointments themselves were the most expensive aspect of treatment.

Olivia Nelson | Mustang News

Health Center doctors were unable to comment, but they cannot legally begin treatment without approval, according to CSU policies.

“CSU’s campus health centers provide basic healthcare services (as outlined in the policy). They may provide referrals to connect students with services not offered on campus, such as hormone therapy,” Chapin wrote in an email to Mustang News.

Universities of California (UCs), however, typically cover both Hormone Replacement Therapy and Gender Affirmative Surgeries.

“I think the student Health Center should be pretty well-primed to take care of the average young, healthy transgender person,” Taylor said.

Chapin did not respond to additional emails asking why HRT is not considered a basic healthcare service. For Ford, she said HRT was life-saving. She said she felt isolated and trapped in a downward spiral prior to HRT.

“I personally felt unlovable due to what my body was like,” Ford said. “To be able to have this space on campus to get hormones and to get treatment and to just learn what it is to be yourself, without those constraints of your previous hormonal balance, is more than vital. It’s lifesaving.”

A 2014 study by the American Foundation for Suicide Prevention found that transgender and gender non-conforming individuals reported an increased number of lifetime suicide attempts compared to cisgender individuals.

The article authors suggested that wanting but not having access to transition-related healthcare services and procedures may increase suicide attempts.

Ford said if she had to wait any longer for HRT, she might have had suicidal thoughts.

“This is why HRT is needed,” Ford said. “Because if I kept going like this [without treatment], I know two years, five years down the line, I would hate myself so much that, yeah, suicide seemed like a likely option.”

Forestry and natural resources freshman Jesse Declan O’Brien said his insurance is located in the Bay Area, so he would be unable to pay for his treatment in San Luis Obispo. On top of that, he is a freshman and does not have access to a car to travel to treatments.

If Cal Poly provided HRT services, it would make it a whole lot easier for me to access them, and I would not need to go all the way back home to visit an endocrinologist for [testosterone] level check-ups,” Declan O’Brien said.

The CSU system has little demographic data on the transgender and gender nonconforming student population. Every CSU separates gender data by men and women. Diversity and Inclusion Vice President Jozi De Leon said Cal Poly does not track the number of gender non-conforming students. 

Two years ago, the UC system added gender-variant options to their college applications, but they have yet to release the data.

“That’s equivalent to erasing us,” Ford said. “They’re still fitting us into these very restrictive boxes and then not understanding why there is pushback from students.”

“They’re still fitting us into these very restrictive boxes and then not understanding why there is pushback from students”

Although all 23 CSUs have some sort of resource for the LGBTQIA+ community in the form of pride centers and safe spaces, the system has no mandated systemwide policy that requires universities to even provide resources at all, according to Chapin.

Ford said she does not advocate for HRT on campus for herself, but for other transgender students who are unable to make the drive to an off-campus provider.

“If just one individual gets helped at the Health Center, then that’s one more individual that doesn’t have to suffer,” Ford said.

Ford teared up as she said her treatment saved her life.

“It’s not a miracle drug, of course,” Ford said. “But when your body is operating on the right hormones, the depression starts to fade, the anxiety is less than present in your mind a lot of the time, and your body starts to look like what you wanted to see.”

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