Deadnames in a living system

Third-year biology student Oliver McDonald dreads going to the doctor’s office or any establishment that requires him to make use of his deadname.

“You have to hear your name over and over and over,” said McDonald. “And you have to sign forms with your name, and you have to initial. I can understand why someone would not get those services because it’s just so dysphoria-inducing.”

To avoid the name mismatching chaos, McDonald said he now carries his birth certificate with him to all medical appointments.

McDonald is not alone in his complicated relationship with accessing health care services. A 2020 study by Trans PULSE Canada found that 45 per cent of transgender individuals claimed to have unmet health care needs compared to only 4 per cent of cisgender individuals.

Canadian transgender and non-binary adults are also more likely to face insurance-based discrimination than cisgender adults, according to a 2020 study from the University of Michigan. For many trans students, access to quality health insurance is a necessary step in their gender-affirming transition.

All that glitters is not covered

UBC students are eligible for the AMS/GSS Health and Dental Plan, which is provided by Pacific Blue Cross. This plan covers most hormone therapy including androgen blockers, estrogen, and testosterone. BC residents are also eligible for the Medical Services Plan (MSP) which covers some gender-affirming surgeries such as vaginoplasty and hysterectomy, among others.

Students who are children of faculty are covered under faculty insurance which includes some gender-affirming care.

For McDonald, switching over to the AMS/GSS health insurance plan meant no longer having nearly all of his medications covered. Now, he spends $30 to $60 monthly on testosterone. Though this is at least partially subsidized, it is still a “significant amount [to pay] per month.”

What’s in a name?

As UBC does not have an option for legal name adjustments in the Student Service Centre, McDonald had to go through a “weird” and complicated process of changing his name in the UBC system.

After that process, McDonald still ran into trouble with his name.

“MSP, and I assume UBC’s insurance, [take] forever to change it in the system,” he said. “In the UBC system, I’m known as Oliver but all of my insurance information and all of my medical documents still have my old name.”

A simple visit to the doctor’s office or a quick blood work appointment have led to “kerfuffle[s]” when McDonald’s name did not match insurance documents on file.

To insure or not to insure

Faculty insurance, which is accessible to students who are children of faculty members, has its pros and cons as well.

“I would say [faculty insurance] is probably more generous [and] expensive than the AMS/ GSS plan but it does have its own pitfalls,” said Casey Broughton, a fifth-year mathematics student.

“Overall, it’s been extremely helpful. I’ve benefited for a long time from the fact that it covers pretty much any medication that’s prescribed by a doctor as long as it’s prescription and that’s been huge, because one of the medications I’ve been on for years is $400 a month.”

Despite having a clinician’s prescription, faculty insurance did not cover laser hair removal, Broughton explained. Some other gender-affirming procedures can be out of reach for students as well. As breast implants are considered cosmetic surgery, they are not covered by faculty insurance, along with breast forms.

“I find it especially frustrating that … [faculty insurance] covers 80 per cent [or] up to $600 of speech therapists, acupuncturists, chiropractors, naturopaths, homeopaths, podiatrists, osteopaths, dieticians, audiologists or occupational therapists,” she said. “But they don’t cover gender-affirming care, other than what is incidentally covered by mental health care and pharmaceuticals.”

For students who are not satisfied with health insurance, The Pride Collective runs a gender-affirming store with a sliding scale of payment, explained Broughton. She recommended that students email the Pride Collective with “gender empowerment store” as the subject if they are struggling to get certain things, like binders or breast forms, covered. The AMS did not respond to multiple requests for comment.

This above all: To thine own self be true

While the students interviewed were happy to have access to health insurance, both had experiences which aggravated feelings of dysphoria, particularly surrounding name changes and cosmetic care.

“I’m grateful to have [insurance coverage],” said Broughton. “It’s more generous than a lot of health plans, but there’s a lot of room for improvement — especially around the areas of acknowledging that trans-care exists, other than just covering the medication for it.”