Trans students still face barriers to gender-affirming care at UBC

Student Health Services hired a primary care provider with extra training in gender-affirming care in late 2021, improving healthcare access for Trans students.

But half a year later, Trans students say knowledge about this provider is still limited, and that the AMS/GSS Health and Dental Plan could do more to improve financial access to gender-affirming services.

Ev, a Trans student whose name has been changed for privacy reasons, said that in May 2021 before Esbak was hired, a Student Health Services (SHS) general practitioner was unable to prescribe her hormone replacement therapy (HRT).

Ev said the GP referred her to an endocrinologist who could prescribe HRT, but Ev had to wait a month for the appointment. During this time, she was taking hormone blockers but not replacing them.

“I had to wait an additional month to get [the hormones] I needed, and during that time I was dealing with this GP at Student Health Services who seemed completely clueless,” she said. 

Dr. Simon Chen, interim medical director at SHS, wrote in a statement that SHS saw an increase in need for gender-affirming care in recent years, and sought to fill the gap. 

“[When hiring] we also consider any special skills or training they can bring to SHS to compliment the team … one of these special skills is Trans affirming care," he said.

In late 2021 SHS hired Niloo Esbak as a primary care provider at the SHS Orchard Commons site. She received extra training in gender-affirming care, and is offering it as part of her role.

Chen said he thinks Esbak’s hiring will significantly reduce wait times for students seeking those gender affirming services. 

Magreta, a Trans student whose last name was omitted for privacy reasons, said in an interview that Esbak was able to provide “Trans competent” care and prescribe HRT. 

Yet Magreta said knowledge of Esbak’s services is still limited. She found out through The Pride Collective’s Discord server. 

“Everyone … who is working with her right now only knows about her existence through that same word of mouth network,” she said. “Advertising that Niloo is there and offers this service would be hugely beneficial.”

The SHS website does not currently mention it offers HRT assessment or prescription, and is not on the list of reasons to book an appointment — it must be entered manually.  

If a student booked an appointment with a different primary care provider to seek gender-affirming care, Chen wrote that SHS would refer students to necessary services if they did not have the “resources or comfort level to provide care.”

Financial barriers

Getting a prescription is only the first step in gaining access to gender-affirming care — then comes paying for it. 

Under the AMS/GSS Health and Dental Plan, Pacific Blue Cross covers up to 80 per cent of prescription medications, but unless an individual gets special authority from the province, this only includes prescription medications in the Fair Pharmacare formulary. 

Ev said her hormone injections are not in the Fair Pharmacare formulary, and she was only able to get special authority for coverage on some of her HRT. Because of this, she pays nearly $200 per month. 

“All of these things that are not covered need to be covered off the bat,” she said. 

Ev said prescription drugs are not the only coverage gap in the health and dental plan. 

For example, a gender-affirming voice training appointment costs on average $100–140 in BC, but the health and dental plan only covers $20 per appointment.

Rita Jin, former AMS vice-president finance and chair of the Health and Dental Committee, encouraged students to reach out to the committee if they felt coverage was lacking.  

“We’re here to listen and we’re here to help," Jin said. "Hopefully students feel like they are able to contact us."

Jin said the committee is looking into making health care more personalized and accessible for students, but could not speak to specifics. The committee has only met once during the 2021/22 academic year at time of publishing. 

In response to the limited coverage, students have started their own initiatives to offset the high costs of care. One example is the Gender Empowerment Store (GES) — a service run by the Pride Collective that provides gender-affirming products — where Ev is a volunteer.

“It’s removing that financial barrier, for example, to have a binder that’s so essential for Trans people dealing with dysphoria,” Ev said.  

Ev said the GES has completed nearly 100 product orders. 

“There’s definitely a need for this, and it’s really awesome that we’re able to do it.”