Transgender students at Brown often have health concerns that other students may not. They may have concerns about housing, “coming out,” name changes, bathroom use, pronoun use, and safety, among many other things. This page is meant to provide guidance for students who identify as transgender so they may take steps to be in control of their health. Because there is a range gender variant identities, not all of the topics presented will pertain to all students who may identify as transgender. For the purpose of this page, we are using the term “transgender” to refer to those who express their gender differently than how society expects them to based on the sexual anatomy they were born with. This encompasses a range of gender variant identities including, but not limited to, trans, genderqueer, transsexual, FTM (female to male), or MTF (male to female). When we talk about more specific health concerns for transgender students, we will terms FTM and MTF. Again, we recognize that these labels may not be used by all transgender people, and we acknowledge that gender identity is more complex than these two terms.
What are the major health issues facing transgender students? Transgender people often face everyday obstacles that other people may not even think twice about. When at college, students may worry about what bathrooms to use, what housing to apply for, being victims of hate crimes, finding quality health care, and how their roommates, professors, or friends may react if they disclose they are transgender.
Depression and anxiety may be more severe for those who are struggling with the relationship between their gender and society, as well as for those who do not have adequate social support. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive mental health services for transgender students may be more effective in the prevention, early detection, and treatment of these conditions.
Fortunately, Brown is dedicated to providing an environment that creates safety and wellness for transgender students. The LGBTQ Resource Center supports students during their gender exploration and their social or physical transition, if they decide to transition. The Office of Residential Life works to provide housing accommodations that best meet the needs of transgender students. Both Health Services and Psychological Services are dedicated to providing trans-sensitive care to patients. They will also assist patients in finding other medical professionals who can help transgender students obtain the emotional and physical care specific to their needs.
Are trans students at risk for STIs? The risk for sexually transmitted infections (STIs) will depend on sexual behavior and cannot be generalized for the entire transgender population. Trans students can protect themselves and thier partners from STIs by using male and female condoms during oral, anal, and vaginal sex, using dental dams during oral sex, and cleaning sex toys properly. Visit our sexual health page for more information on STIs, safer sex, and sexual communication.
What does it mean if a trans student “transitions”? Deciding whether or not to “transition” can be a complicated choice for many trans students. Some transgender students decide to transition socially, meaning they change their name, use different pronouns, wear clothes and use mannerisms “dedicated” to the opposite gender. Some transgender students may choose to transition medically as well. This may include hormone therapy and chest or genital reconstruction surgeries. Most likely, a surgeon will require a letter from a psychologist, who is working under the “Harry Benjamin Standards of Care” stating that the patient is psychologically ready for any body modification surgeries. Although the transgender community is growing and becoming more visible, research and literature on transgender health remains sparse. It is important to discuss health risks with a medical provider when contemplating any physical changes.
Some people decide to travel outside of the US for surgeries, which is called “medical tourism.” Although medical tourism can provide cheaper surgeries, it also poses many potentially dangerous situations.
Government insurance, basic medical insurance, and extended medical insurance often do not pay for these expensive medical procedures.
There is little follow-up care. The patient is usually in the hospital for a few days. Complications, side-effects, and post-operative care are then the responsibility of the medical care system in the patient's home country.
Most of the countries that offer medical tourism have weak malpractice laws, so the patient has little recourse to local courts or medical boards if something goes wrong.
There are growing accusations that profitable, private-sector medical tourism is drawing medical resources and personnel away from the local population, although some medical organizations that market to outside tourists are taking steps to improve local services.
(source CBC News)
What are the health concerns for FTM students?
Gynecological and breast health
Sometimes, FTM persons dissociate from their breasts and genitals. This may cause physical or emotional discomfort and difficulty finding a medical provider who is sensitive to their needs. Because of this barrier, FTM patients are less likely to receive regular GYN and breast exams in order to maintain a healthy body and detect cancers, STIs, or other illnesses. If an FTM patient has had a mastectomy (“top-surgery”), they should consult with their medical provider about whether or not to continue breast exams, as some breast tissue may still be present.
Additionally, some FTMs bind their chest to create a flat appearing chest. The material used to bind should be able to wick away sweat. If not, sores and other skin irritations can occur. If the binding is too tight it may hurt, cause cuts, irritate the skin, or prevent comfortable breathing. Go here to read tips for binding safely, different methods of binding, and for additional resources.
Hormones
FTM people may choose to use testosterone (“T”) to create changes to their bodies, including lowered voice, redistributed body fat, increased muscle and hair growth, and enlarged clitoris. For some, this choice is made easily, while others will struggle with the idea and may go on and off testosterone at different points in their lives. When considering testosterone, it is important to visit a medical provider for a physical exam and regular updates on blood work and health status. Everybody reacts differently to testosterone and various personal and family health factors will influence how each person will react to use. It is also important to obtain testosterone through a medical provider. Using testosterone that is bought off the “black market” is not only illegal, but unsafe. It may limit access to clean needles (some states require a prescription to buy and carry needles; Rhode Island does not), be impure, and dosage should be decided by a medical provider. Taking more testosterone than prescribed will not speed up the changes desired and may increase the risk of serious side effects.
Possible health effects of testosterone use include acne, balding, increased fat around the abdomen, high blood pressure, high cholesterol, and liver problems. Medical research has not yet determined the long-term effects of using testosterone. It is still possible to become pregnant while on testosterone, although infertility occurs after continued use. Speak to your medical provider for more information about fertility and contraception options if pregnancy is a concern. Some FTM people choose to have their eggs frozen before starting testosterone, to have the option of using them later, either giving birth themselves or using a surrogate host.
Surgery Some FTMs decide to have reconstructive surgery. Some surgery options are liposuction, breast reduction, double mastectomy, or pectoral implants (“top surgery") and various “lower surgeries” including testicular, metoidioplasty (clitoral hood release), phalloplasty (construction of a penis), and hysterectomy (removal of the uterus). As with any surgery, there can minor or major complications during and after these procedures. It is important to follow the guidelines given by your surgeon and medical provider at all times. These surgeries are expensive, and may require time off work and traveling expenses. Not everyone will be a candidate due to other medical conditions. Most respected surgeons in the US will also require a clearance letter from a psychologist, in compliance with the Henry Benjamin Standards of Care. You can find more information on hormones and surgeries at Medical Therapy and Health Maintenance for Transgender Men.
What are the health concerns for MTF students?
Hormones
Some MTF people will choose to use estrogen to create changes to their bodies like softer skin, weakened muscles, redistributed body fat, and breast development. For some, this choice is made easily, while others will struggle with the idea. Those who are considering estrogen therapy should visit a medical provider for a physical exam and regular updates on blood work and health status. Everybody reacts differently to estrogen therapy and various personal and family health factors will influence how your body reacts to it.
It is important to only use estrogen obtained through a prescription. Using estrogen that is bought off the “black market” is not only illegal but unsafe. It may limit access to clean needles (some states require a prescription to buy and carry needles; Rhode Island does not), be impure, and proper dosage should be decided by a medical provider. Regular breast self exams (BSE) should be performed once breast tissue growth occurs.
Side effects of taking estrogen include weight gain, reduced libido, loss of the ability to achieve an erection, decrease in penile size, and reduction of sperm count. Other common side effects include mood swings or moodiness, altered perceptions, and changing hunger patterns. Smoking while using estrogen therapy increases the risk for blood clots. This may lead to heart attacks, strokes, or other permanent damage. Although there may be a reduction in sperm count when taking estrogen, it is still possible to impregnate someone, especially during the first year of estrogen use. Some MTFs choose to have their sperm frozen prior to starting hormone therapy, in order to have it available for later use.
Silicone and Oil Injections
It is dangerous to inject silicone or oils in order to add to your cheekbones, lips, thighs, breasts, hips, buttocks, etc. Silicone is toxic to the body and can lead to serious health risks, such as pain, swelling, blistering of the skin, and disfigurement. The FDA has never approved silicone injections for sale for human use. For more information, check out “Silicone Use: Illicit, Disfiguring, Dangerous.”
Surgeries
Some MTFs decide to have reconstructive surgery or electrolysis for hair removal. Some surgery options are breast augmentation, tracheal shave, orchiectomy (removal of testicals), and vaginoplasty (creation of a vagina). As with any surgery, there can minor or major complications during and after these procedures. It's important to follow the guidelines given by the surgeon and medical provider at all times. These surgeries are expensive, and may require time off work and traveling expenses. Not everyone will be a candidate due to other medical conditions. Most respected surgeons in the US will also require a clearance letter from a psychologist, in compliance with the Henry Benjamin Standards of Care.
How can I support my transgender friend or family member?
Family members and friends of trans students may experience stages of denial, confusion, and grief, along with concerns about safety. Here are a few things that you can do to show support for the trans person in your life, as well as yourself.
Learn more about what transgender means. Read books and websites by or about trans people. Attend workshop or conferences on LGBTQ issues.
Talk to the transgender person in your life. Find out what name and pronoun they prefer and ask how they would like you to support them.
Take time to think about what you know about transgender people, what your assumptions are, what things might be hard for you, and what questions you may have.
Get support for yourself, such as individual or group counseling and attend support groups.
Speak out against anti-trans behavior. Let people know you don’t want to hear offensive slang, stereotypical remarks, or put downs about trans people. Share your knowledge and experiences with those around you.
There are many resources, both locally and nationally, that offer support services for friends and family members of transgender people. Parents, Families & Friends of Lesbians & Gays (PFLAG) promotes the health and well-being of gay, lesbian, bisexual and transgender persons, their families and friends through support, education, and advocacy, to end discrimination and to secure equal civil rights. On campus you can contact the LGBTQ Resource Center (863-3062), Health Education (863-2794), and Psychological Services (863-3476).
Is intersex the same as transgender? No, an intersex person is born with reproductive organs that are neither exclusively male nor female. Approximately 1 in 2000 people are born with ambiguous genitalia. However, some people do not find out they have intersex anatomy until puberty. Sometimes parents will decide to have genital surgery performed on an intersex baby. The decision to perform surgery on a baby is a highly debated topic. Some people feel that performing the surgery allows for better psychological health. Others believe that there’s virtually no evidence that people with “uncorrected” intersex genitals suffer increased rates of psychological illness, and that more distress can be created for people who have had the surgery. You can visit the Intersex Society of North America for more information on support resources.
The LGBTQ Resource Center is a safe space for all students, staff, and faculty dealing with questions of sexual orientation and gender identity. It offers confidential support, information, and referrals for LGBTQ individuals and the people in their lives. Additionally, it offers fellowship advising and assistance with academic projects, as well as educational workshops.
Youth Pride, Inc. (YPI) is Rhode Island’s only statewide nonprofit organization with programming dedicated to meeting the social, emotional, and educational needs of youth and young adults impacted by sexual orientation and gender identity. The drop-in center offers support services, social activities, and outreach opportunities for youth ages 13-23.
An advocacy, educational, and support organization dedicated to meeting the needs of transgender, transsexual, Two Spirit, genderqueer, and intersex people in Rhode Island.
An online magazine of health and fitness for transsexual and transgendered people, consisting of articles written by people from around the world.
Offers online resources focusing on the needs, issues, and concerns of gender variant people in society.
A website offering resources for people seeking information and advice about atypical reproductive anatomies and sex development disorders.
Offers a variety of health resources for LGBTQ people.
Offers resources, materials, and trainings designed to improve the quality of health care provided to LGBTQ people.
PFLAG promotes the health and well-being of gay, lesbian, bisexual and transgender persons, their families and friends through support, education, and advocacy.
A place where people of all genders can discuss gender theory, the trans community and its various identities, both as a part of the academic world and day-to-day life.
Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.
