This page is meant to provide information and resources for trans students at Brown so you can take steps to be in control of your health. Because there is a wide range of gender identities and experiences, not all of the topics presented below may be relevant for you.
How do I prepare for a visit to Health Services?
Sometimes you might feel uncomfortable seeking health care because of concerns you will experience transphobia and the concern that you will not receive appropriate and sensitive care. This can make it harder to seek health care when you need it. At Health Services we strive to be a safe space for trans students to seek appropriate, sensitive, non-discriminatory health care. If you are a Brown student with feedback about how we can improve our services, please contact [email protected].
On a visit to Health Services you can expect to receive care that is sensitive to you as a trans person and responsive to health care concerns you might have. Questions about your health behaviors and sexual activity are not intended to stereotype you and are not based on assumptions about how you behave. Rather, they're a standard part of care at Health Services. A good medical provider will ask questions about your health behavior in a sensitive way, not making any assumptions, but assessing your level of risk. However, if you ever don't feel comfortable answering a question, just say so. Remember that your visits to Health Services are covered by medical confidentiality laws.
You play an integral part in the health care you receive. Communicating openly and honestly with your medical provider is an important way to receive comprehensive and sensitive medical care. This includes talking about issues like sex and gender. It's also important that you feel like you can ask questions of your provider. We suggest that you find a provider at Health Services that you feel comfortable with to take the lead on your medical care. While all providers are available to you, this person will come to know your history well and, by building a relationship with this provider, you can optimize your health care and feel safer discussing your concerns and issues. Ask around about which providers your friends use or make a point of meeting different providers when you schedule appointments.
One way to approach a trip to Health Services if you're nervous is to do some research before you come in. Think about and read about any specific health concerns you may have. See the health concerns list below for specifics that you might not have thought about. If you have questions for your provider, write them down and bring them in -- sometimes it's hard to remember all of your questions once you're in the exam room. Remember that you can tell your provider if you are nervous and they can help you through the questions.
Finally, patient comments are very important to us. If you have any feedback about our services, good or bad, please fill out the patient survey which will be sent after your appointment and which is also available on the Health Services website. Health Services administrators address all complaints, and the more specific you are, the better they will be able to fix the problem. If you choose to leave your name, they will follow up with you. You can also contact [email protected]. Lynn is the Associate Director of Health Services and she is part of the team that follows up on all student feedback.
Health Services is located at 13 Brown Street on the corner of Brown and Charlesfield Streets. Brown student can call 401.863-3953 to make an appointment.
What steps is Health Services taking to become more welcoming to trans students?
Health Services is engaged in an ongoing effort to be more welcoming and to improve our care for trans students. This work includes:
Ongoing training for medical providers.
Ongoing training for medical assistants and schedulers.
A comprehensive and ongoing review of our services, including forms, signs and posters in the building, and the Health Services and Health Promotion websites, to identify areas for improvement.
Throughout this ongoing learning process, we welcome trans students to utilize our services and we would be grateful for any feedback you can offer us. If you have any concerns or questions about care at Health Services, please contact [email protected]. Lynn is the Associate Director of Health Services and she follows up on all student feedback.
Is my visit to Health Services confidential?
Yes. All visits to Health Services are confidential. In addition, the staff at Health Services is accustomed to working with students who are concerned about confidentiality issues related to insurance billing (this is a common concern for students who are on their parents' insurance plans) and we can work with you to negotiate this issue as well.
Visits to Health Services providers are covered by the Health Services fee paid by all students. There is no office visit charge. Lab charges and prescriptions are not covered by the fee. These charges can be billed to insurance or paid for out of pocket. Individual insurance coverage will vary, but Health Services will help you understand the insurance billing process.
Are hormones available at Health Services?
To begin using hormones, Health Services would refer you to a specialist in hormone therapy. Once the specialist prescribes hormones, Health Services' providers can work with you and the specialist to have your prescriptions filled here at Health Services. As mentioned above, we will work with you regarding the insurance billing process.
What supports does Brown offer for safety and wellness?
Brown is dedicated to providing an environment that creates safety and wellness for trans students. The LGBTQ Center can offer support for gender exploration and during social or physical transition. The Office of Residential Life works to provide housing accommodations that best meet the needs of trans students. Both Health Services and Counseling and Psychological Services strive to provide trans-sensitive care to students. They will also assist you in finding additional medical professionals who can help you obtain the emotional and physical care specific to your needs.
Even with these support services, you may still find that you frequently face obstacles and you may also worry about and experience discrimination and violence. Experiences with others' transphobia can sometimes lead to mental health concerns, such as depression, anxiety and risk of suicide. Because of all these concerns, this page will offer you links to resources that can offer you support and care and information to help you navigate your time at Brown.
What are common health issues for trans women?
You may choose to use estrogen to create changes in your body like softer skin, smaller muscles, redistributed body fat, and breast development. For some, this choice is made easily, while others will struggle with the idea. If you are considering estrogen therapy 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 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 illegal and unsafe. It may limit your access to clean needles (some states require a prescription to buy and carry needles; Rhode Island does not), and it can be impure (cut with other substances). It also critical to use the appropriate dosage as determined by a medical provider. Taking more estrogen than prescribed will not speed up the changes desired and may increase the risk of serious side effects. Regular breast self exams (BSE) should be performed once breast tissue growth occurs.
Side effects of taking estrogen can 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, altered perceptions, and changing hunger patterns.
Smoking while using estrogen therapy increases the risk for blood clots, which can 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 get someone pregnant, especially during the first year of estrogen use. Some people 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."
Some people decide to have reconstructive surgery or electrolysis for hair removal. If you decide to have surgery, some options are breast augmentation, tracheal shave, orchiectomy (removal of testicals), and vaginoplasty (creation of a vagina).
If, as part of a vaginoplasty, tissue from the penis is used to create a neo-cervix, you should ask your provider about beginning to get regular GYN screenings, including Pap smears.
If you have orchiectomy surgery (removal of the testicles), bone density screenings are recommended as appropriate.
As with any surgery, there can be 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 from school or work. Not everyone will be a candidate due to other medical conditions. Most surgeons in the US will also require a clearance letter from a psychologist, in compliance with the WPATH Standards of Care.
What are common health issues for trans men?
Gynecological and breast/chest health
Sometimes, someone may dissociate from their breasts and genitals. This can cause physical or emotional discomfort. Additionally, you may find it is difficult to find a medical provider who is sensitive to your needs. Because of these barriers, you may be less likely to receive the regular medical exams--including GYN exams and breast or chest exams--which are important to maintain a healthy body and detect cancers, STIs, or other illnesses.
If you bind your chest, make sure that the material used to bind can 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.
If you have had a mastectomy, you should consult with your medical provider about whether or not to continue breast exams, as some breast tissue may still be present.
Unless you have had a hysterectomy, regular GYN exams and pap smears remain an important piece of your total health care.
You may choose to use testosterone (“T”) to create changes to your body, 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. 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 illegal and unsafe. It may limit your access to clean needles (some states require a prescription to buy and carry needles; Rhode Island does not), and it can be impure (cut with other substances). It also critical to use the appropriate dosage as determined 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 people choose to have their eggs frozen before starting testosterone, to have the option of using them later, either by giving birth themselves or by using a surrogate.
If you decide to have surgery, surgery options can include 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 be 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 also require time off from school or work. Not everyone will be a candidate due to other medical conditions. Most surgeons in the US will also require a clearance letter from a psychologist, in compliance with the WPATH Standards of Care.
How can I support my trans friend or family member?
Here are a few things that you can do to show support for the trans person in your life:
Learn more about what trans means. Read books and websites by or about trans people. Attend workshop or conferences on LGBTQ issues.
Talk to the trans 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 trans 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 trans people. Parents, Families & Friends of Lesbians & Gays (PFLAG) promotes the health and well-being of gay, lesbian, bisexual and trans persons, and 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 Center (401.863-3062), Health Promotion (863-2794), and Counseling and Psychological Services (863-3476). The Queer Alliance (a student group) is another important on-campus resource.
Brown LGBTQ Center 401.863-6062
The LGBTQ Center is a safe space for all students, staff, and faculty dealing with questions of sexual orientation and gender identity. The Center 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.
BWell Health Promotion 401.863-2794
Health Promotion is available for individual appointments and group education on a variety of health issues, including LGBTQ health, alcohol, other drugs, nutrition and safer sex. We have condoms, lube, and dental dams available at no charge. Come visit us, we are located on the 3rd floor of Health Services.
Health Services 401.863-3593
Health Services provides a range of services including general health care, STI testing, and emergency medical care. You can request a specific medical provider by name or by gender. We are located at 13 Brown Street on the corner of Brown and Charlesfield Streets. Brown students can call 401.863-3953 to make an appointment.
Counseling and Psychological Services 401.863-3476
Counseling and Psychological Services provides assessment, brief psychotherapy, and crisis intervention for Brown students.
Chaplain's Office 401.863-2344
The Chaplains are available for personal counseling about religious and social issues, parental and peer difficulties, career choices, interpersonal relationships and sexuality. A number of programs are offered during the year that include ecumenical discussion groups, innovative worship experience, ecumenical services, and dramatic and artistic events.
The Queer Alliance serves as an umbrella organization for a number of groups on campus. Its mission is to be a multifaceted service to the LGBT community by offering resources through subgroups, community discussions, and events. The LGBTQ Resource Center (Faunce House, Room 321) has a wide array of queer-related books, movies, literature and resources. You can e-mail [email protected] for more information or to get involved.
Transgender Health Information Program
Information on hormones, surgery, and voice changes plus guides for trans patients on health issues including body image and weight, cancer, vaccinations, diabetes, osteoperosis, and cardiovascular disease. This site also has clinical protocols for trans health care.
Youth Pride, Inc. 401.421-5626
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.
TGI Network of RI
TGI Network of Rhode Island is a statewide organization serving the needs of the transgender, gender-variant, and intersex (TGI) communities in Rhode Island and surrounding areas through support, advocacy, and education.
Trans Student Educational Resources
Trans Student Educational Resources is a youth-led organization dedicated to transforming the educational environment for trans and gender nonconforming students through advocacy and empowerment. In addition to a focus on creating a more trans-friendly education system, their mission is to educate the public and teach trans activists how to be effective organizers.
The GLBT Health Access Project
Offers resources, materials, and trainings designed to improve the quality of health care provided to LGBTQ people.
PFLAG Parents and Friends of Lesbian and Gays
PFLAG promotes the health and well-being of gay, lesbian, bisexual and transgender persons, their families and friends through support, education, and advocacy.
Advocates for Youth
Advocates for Youth has developed programs to help decrease the isolation felt by many LGBTQ youth. It offers a variety of research based approaches, designed to decrease health disparities in LGBTQ communities, which can be used by both LGBTQ community members and allies.
FTM International provides information about female to male transgendered people, through their newsletter and other publications, through support from volunteers who are willing to help if you need someone to talk to, or through our list of online mailing lists and links, and also through their monthly meetings, calendar and special events.
The National Coalition for Lesbian, Gay, Bisexual, and Transgender Health
The National Coalition for Lesbian, Gay, Bisexual, and Transgender Health is committed to improving the health and well-being of lesbian, gay, bisexual and transgender individuals and communities through public education, coalition building and advocacy that focuses on research, policy, education and training.
Fenway Community Health
Fenway Community Health is a Boston based clinic that serves LGBTQ patients. Their webpage offers a variety of health information needs, as well as research and resources outside of FCH.
CDC Transgender Health Page
A variety of information on important health issues, including safer sex and STI information.