UHS ‘breaks down barriers’ for trans students seeking medical care

In addition to worrying about roommate assignments, meal plans and class choices, perspective transgender, non-binary and gender non-conforming students routinely worry about resources regarding medical care available at UW-Madison before arriving on campus.

In the past, students have chosen UW-Madison in part because of the services offered at University Health Services that aren’t commonly offered on other college campuses — however, barriers have persisted to medical care access within UHS.

Now, staff members from UHS and the LGBT Campus Center are shifting toward a model that will help create an affirming, inclusive space for students, according to LGBTCC Assistant Director Katherine Charek Briggs.

Come May, UHS will move to informed consent as a model of health care, a shift Charek Briggs said gives patients agency in their own medical care.

Informed consent allows patients to make decisions about their own health care after being fully informed of benefits and consequences by their medical provider. Since 2012, UHS has required trans students to go through a Gender Identity Consultation with a trained therapist or counselor prior to receiving medical care. Patients must then obtain a written letter from that counselor, permitting them to receive the treatment they seek.

The informed consent model enables patients to forgo mental health counseling and consult directly with a doctor who can prescribe them hormones, which can also be administered at UHS — one of the services not commonly available on other college campuses.

UHS is the first Big Ten university health center to switch to informed consent practice. They are also the first of the UW System schools to do so, according to Charek Briggs.

Shannon Juniper Neimeko, an associate counselor at UHS who focuses on trans health, said not requiring students to meet with a mental health provider eliminates some stigma surrounding being trans.

“One of the things we want to emphasize is to really set things up in a way so that we can communicate to students we know that being trans isn’t a mental health condition,” Juniper Neimeko said. “It's a medical condition that can be treated in the same way other medical conditions are treated, this is how medicine is delivered in every other case. So, let's connect with that and offer that in a way that’s consistent.”

To push the change forward, Charek Briggs and Juniper Neimeko offered a training for UHS staff medical and mental health providers. They shared information about identity, how biases appear in health care practices and how the model will work, and has worked at other care centers previously. They will also meet with providers monthly to workshop the model as it unfolds.

“Providers who are new to this model seeing that [informed consent] will be successful and how students respond goes towards the agency being more competent working with transgender and gender-nonconforming people,” Charek Briggs said. “This is just an important but routine part of your practice. It’s about normalizing care of TGNC people.”

Although informed consent allows patients to opt out of meeting with a mental health counselor before seeing a medical provider, Juniper Neimeko said the model serves as a sort of “mental health intervention.”

She said data indicates patients who have barrier-free access to gender-affirming care show decreased levels of anxiety and depression. The goal is to make TGNC patients feel comfortable accessing care they may have hesitated to seek due to bias based on one’s identity.

Charek Briggs said informed consent will “diversify the narrative” around TGNC patients, who may not be interested in a medical transition. Other resources will remain available, including support groups offered at UHS and the LGBTCC, as well as mental health providers who are trained to handle trans health, such as Juniper Neimeko. This combats the misguided conception that medical transition is required to “legitimize” TGNC, according to Charek Briggs.

Charek Briggs worked with the group that implemented UW-Madison’s current model for trans health care. Charek Briggs has collaborated with other UW System four year schools to adopt that same model, but said those institutions, like UW-Madison, are ready for the change to informed consent.

Charek Briggs emphasized this is not a special favor given to UHS patients — Charek Briggs and Juniper Neimeko said informed consent is the best standard medical practice, both for current students and the scores of TGNC students who are considering attending UW-Madison.

“It’s a big reminder that this is baseline practice in a lot of places and for a lot of people; it should have been happening a long time ago, it should be a lot easier,” Charek Briggs said. “It is not a special favor, it’s trying to intervene in bias and barriers that have been here for a really long time.”