Transgender Health Information  

For students who identify as part of the transgender community, and have begun, or are beginning, their transition, there are a number of processes that can be followed. Major points of contact include the UC San Diego’s LGBT Resource Center, Student Health Services, and Psychological & Counseling Services. All of these agencies should have an understanding of the health insurance policies that come into play, the competency to address the needs of transgender students, and the ability to communicate to each other regarding the services you may be seeking. These processes are set forth as a way of understanding the way you may access the health services you need.

• LGBT Resource Center

  Students who are transitioning/transitioned and are beginning to live/living full time in their appropriate gender expression may begin by accessing the LGBT Resource Center to connect with other community members, as well as gather information about the competency levels of other units within the institution regarding transgender issues.

• Student Health Services

• Hormones

Students who are interested in beginning hormones may begin by accessing Student Health Services. Medical practitioners at Student Health Services may be able to continue courses of hormones that have been previously proscribed by other medical professionals that the student has secured hormones from in the past. Students who have never been on hormones may need further diagnosis and evaluation. Medical staff at the Student Health Service can assist with this.

• Surgery

  Students who are interested in surgery are currently unable to receive any necessary surgeries at an UC San Diego medical facility. However, in order to be able to seek our insurance coverage for surgery through the policy currently in place, students needs written support from two medical and/or mental health professionals. Student Health Insurance is underwritten by National Union Fire Insurance Company. They have established a number of procedures and protocols that are required to access surgeries. The entire insurance policy, with highlighted sections, can be accessed via this link. The transgender medical necessity criteria that the policy follows is provided by a third-party administration office, Personal Insurance Administrators (PIA). There criteria regarding UCSD’s insurance coverage is available at this link. The criteria indicates that:

  A qualified mental health professional* who has been acquainted with the member for at least 18 months recommends sex reassignment surgery documented in the form of a written comprehensive evaluation; and A second concurring recommendation by another qualified mental health professional * must be documented in the form of a written expert opinion**;
  
  * At least one of the two clinical behavioral scientists making the favorable recommendation for surgical (genital and breast) sex reassignment must possess a doctoral degree (e.g., Ph.D., Ed.D., D.Sc., D.S.W., Psy.D., or M.D.).
  
  ** Either two separate letters or one letter with two signatures is acceptable.

• Pre certification for surgery

In order to access surgical services, transgender students need to go through the Utilization Review Organization, which is a part of the insurance process related to PIA (see above) and the insurance underwriter, National Union Fire Insurance Company. The medical professional at Student Health who you are working on hormone therapy should suffice to provide one of the two required signatures to move forward with a pre-certification request to the Utilization Review Organization. The letter which the provider will write follows the same processes as described below, although only needs to document the issues related to the medical treatment (i.e. hormone therapy). You can provide a timeline of hormone treatment and attending medical professionals if the hormone therapy has been occurring in multiple locations.

A mental health professional also needs to provide “a written comprehensive evaluation” as indicated above from the transgender medical necessity criteria provided by PIA. The World Professional Association for Transgender Health specifies exactly what needs to be in a letter:

The Mental Health Professional’s Documentation Letter for Hormone Therapy or Surgery Should Succinctly Specify:



1. The patient's general identifying characteristics;

2. The initial and evolving gender, sexual, and other psychiatric diagnoses;

3. The duration of their professional relationship including the type of psychotherapy or evaluation that the patient underwent;

4. The eligibility criteria that have been met and the mental health professional’s rationale for hormone therapy or surgery;

5. The degree to which the patient has followed the Standards of Care to date and the likelihood of future compliance;

6. Whether the author of the report is part of a gender team;

7. That the sender welcomes a phone call to verify the fact that the mental health professional actually wrote the letter as described in this document.

The organization and completeness of these letters provide the hormone-prescribing physician and the surgeon an important degree of assurance that mental health professional is knowledgeable and competent concerning gender identity disorders.

See pp 7-8 of the entire Standards of Care which are available here.

The standards of care appear to require a diagnosis of gender identity disorder, but it is not completely clear. You may be particularly uncomfortable with a diagnosis regarding a disorder. However, the Sample Letters for Hormone Therapy, available here provide a helpful starting place for language that may be appropriate for the letter.

• Psychological & Counseling Services

Students who are struggling with their gender identity, or issues related to gender identity, may access Psychological & Counseling Services as a first point of contact. Students who have significant issues that can only be addressed with care beyond the length currently available through Psychological & Counseling Services may be referred to on off campus provider that is knowledgeable about transgender.