Trans and Nonbinary Care

“Progress” Pride Flag by Daniel Quasar, used with permission

Services Overview    Hormone Therapy    Surgery

Vocals and Hair    Legal & Records    Mental Health

Insurance and Financial Aid    Trans Care Team   Questions

Welcome!

We recognize that every individual is unique, so we are committed to working with YOU to develop a personalized health care plan that meets your needs and goals. We want every student to feel comfortable and safe advocating for the care they need. We believe good health means caring for both the body and the mind, so we have assembled a team of health care providers to ensure you receive comprehensive services to support your well-being. 

Services Overview

What medical services are available for me at the UCSC Student Health Center?

  • Hormone replacement therapy
  • Referral for fertility preservation
  • Referrals for gender-affirming surgeries (e.g. top surgery, bottom surgery, facial feminization)
  • Referrals for additional specialized care (e.g. vocal training, hair removal)
  • Routine physicals and general primary care (e.g. respiratory illness, diabetes, asthma, high blood pressure, immunizations, minor injury, etc.)
  • Gynecological care
  • Cervical cancer screenings
  • Breast/chest health screening
  • Contraceptive care (birth control)
  • STI (sexually transmitted infection) testing, diagnosis, and treatment
  • Nutritional counseling

In addition to your medical care at the Student Health Center, you’ll find more health services next door in our East Wing. Check out the pharmacy (ground floor), SHOP for support for safer sex and alcohol and drug use (next to the pharmacy), and CAPS for mental health support (upstairs).

How do I schedule an appointment? 

Whether you are ready to start hormone therapy or just want to learn more about it, we welcome you to schedule a consultation with one of our medical providers. We offer in-person, telephone, or telehealth (Zoom) appointments.

Call the appointment desk at 831-459-2500 and ask for trans- or gender-related care. You can also book your appointment online with Health e-Messenger. Select "Telehealth Transgender/Non-Binary Care Visit."

Within a few days of scheduling your appointment, a case manager will  reach out to you to review insurance information and provide an overview of the hormone initiation process at our center.

Hormone Therapy

What is Hormone Replacement Therapy (HRT)?

We recognize that "masculine" and "feminine" are imperfect concepts. We use the terms to describe hormone therapy and body changes.

I’m non-binary, can I access Hormone Therapy? 

Absolutely! There are many Non-binary, gender queer, agender, and gender expansive students that access Hormone Therapy with the UCSC Health Center. The trans care team will work with you to co-create a plan of care that feels affirming, goes at your speed, and helps you reach your goals. 

Which medications are available and what are the typical doses?

The table below has the most commonly prescribed medications and typical dose ranges for each medication. Your health care provider will work with you to figure out which medications and doses are the best for you. Every individual’s body is unique, so the medication regimen will be adjusted according to how your body responds to the regimen. The general practice is to go “low” and “slow” so that your body has the chance to adjust to the medication. 

With testosterone (masculinizing hormone therapy), most individuals will notice some changes within 6 months. With estradiol (feminizing hormone therapy), the changes can take longer, often 6 months to a few years.

See these typical medication doses for hormone replacement therapy for estimates.

What is Low Dosing? 

Low dosing (or what you may have heard as “microdosing”) means taking a lower dose of hormones for hormone replacement therapy. In the chart below you will see examples of what a lower dose is.  When you are taking or administering lower doses of hormones, physical changes can happen more gradually as well as be more subtle. 

Why would someone choose a low dose instead of doing a standard dose? There are a variety of reasons. Some individuals that have pre-existing medical conditions may opt for a low dose to avoid HRT having a negative impact on their health. Some individuals desire more subtle changes. Speak with your provider to discuss the specific changes you want to see, so they can suggest doses that may work for you.

See these typical low-dose hormone replacement therapy amounts.

What standards of care does UCSC Health Center use? 

Our providers utilize the UCSF Transgender Excellence of Care guidelines when we develop an individualized hormone therapy plan.

What is the process for accessing HRT? 

  1. Schedule an initial appointment with a medical provider from the Trans Care Team.
  2. A case manager may reach out to you to review the HRT consent form, insurance information, fertility preservation, and HRT cost. 
  3. A medical provider will order blood tests to do before starting hormones. If you have UC SHIP, the majority of the cost is included in your insurance. If you don’t have UC SHIP, your provider can review options. 
  4. Attend the appointment with the medical provider and if there are no concerns at that time, hormone therapy can be prescribed.
  5. Go fill your prescription at the Student Health Center Pharmacy or you can ask the pharmacy to mail it to you. 
  6. If you are getting an injectable form of hormone therapy (testosterone or estradiol), you will be scheduled with a nurse to get self-injection training.
How do I complete the consent form?

During your initial appointment, the health care provider will review the hormone therapy consent form with you. 

You can meet with a case manager to review the consent form as well.

We encourage you to review the form before the appointment in case you want to ask the medical provider or case manager questions.

Below are the links to the forms:

What blood tests do I need?

Your medical provider will order baseline blood tests (labs that are done prior to starting hormones). Your provider will also order additional labs throughout the time you are taking hormones. These labs ensure there is no harm to your body and that the hormone levels are in the target range.

Lab tests include a complete blood count, comprehensive metabolic panel (kidney and liver function tests), testosterone, and estradiol. Additional tests such as diabetes screening and cholesterol screening can also be ordered. If you have UC SHIP, these labs cost about $10. If you don’t have UC SHIP, the costs will depend on your insurance and your provider will review costs with you.

If you are nervous or anxious about having your blood drawn, that is very common and normal. We recommend hydrating properly a few days before as this makes your veins more visible, as well as notifying the lab staff drawing your blood, so they can help distract you while they complete the blood draw. The blood tests take around 5 to 15 minutes and you will be in and out before you know it.

How do I receive self-injection training?

If your hormone therapy regimen involves self-injection (e.g. testosterone injection or estradiol injection), a nurse will schedule a time to meet with you to review the necessary medical supplies and provide the training. The nurse will give you the first injection and will meet with you regularly until you are completely comfortable giving injections yourself.

How do I get medical supplies?

If your hormone therapy regimen involves injectable testosterone or estradiol, your health care provider will prescribe medical supplies. You can obtain medical supplies through UCSC Pharmacy. Supplies include needles, syringes, alcohol swabs, and a sharps container. The pharmacy offers a starter pack (4-month supply) or a 2-year supply.

How do I get refills for medications started at another clinic?

Our health care providers can prescribe hormones that were started at another clinic. It would be helpful to have your medical records sent to the UCSC Student Health Center before you have your first appointment with one of our medical providers. You would complete a Medical Records Release Form. For any questions or help transferring your records, call our Medical Records office at 831-459-3063.

Fertility Preservation

Because hormone replacement therapy can affect someone’s fertility (ability to get pregnant or have biological children), it’s important to consider whether or not you want to pursue fertility preservation options before starting hormones. Options include egg or sperm freezing. If you’re interested in this, your medical provider will submit a referral for these services to be done at a center that specializes in fertility preservation. UC SHIP covers a portion of the cost. There are a lot of factors and variables to consider, so we encourage you to schedule an appointment with  Lain Lease, Clinical Case Manager, at (831) 459-1476.

Surgery

Students interested in surgery will be referred to specialists off campus. If you have UC SHIP (student health insurance), it is necessary to have a referral from the Student Health Center. Some specialists may require additional documentation or letters from therapists.  We can help you navigate these requirements. Insurance requirements and coverage vary year to year.  You can expect to pay a deductible (the amount paid out of pocket before insurance will pay any expenses) and some percentage of the cost of surgery. The specialist office and our SHS Insurance Office or case manager will help you understand your coverage.  When considering surgery, it is important to get accurate insurance information so you can plan for out-of-pocket costs.

Your insurance may cover: 

  • Top surgery (for example: breast tissue removal, breast augmentation)
  • Bottom surgery (for example: metoidioplasty, phalloplasty, vaginoplasty, vulvoplasty, orchiectomy)
  • Gender affirming facial surgery
  • Tracheal shave
For more information or questions, please contact Lain Lease, Clinical Case Manager, at (831) 459-1476.

Vocal Training and Hair Removal

UC SHIP offers coverage for Vocal Training as well as Hair Removal. What is this? Vocal training is when a licensed speech language specialist works with you to develop a voice that is more in line with your gender identity, including communication patterns, pitch, quality, and resonance. Hair Removal includes laser hair removal or electrolysis. If you are interested in accessing these services it is important to know that you will pay out of pocket for the services and then submit a form for reimbursement.

If you need support with completing these steps, please contact Lain Lease or the Student Health Center insurance office (insure@ucsc.edu). 

Medical and Legal Record Changes

How to Change Pronouns and Name in Medical Record

What are your pronouns? Please let us know! To change your pronouns, visit the Registrar's website.

You can update your name and pronouns in MyUCSC. Students have the option to edit their chosen name, pronouns, and gender

Log into MyUCSC and select the Personal Information tile. Select Preferred Name from the left side menu. You may get an ID card with your preferred name on it by taking a screenshot of your preferred name to ID Card Services.

If you have legally changed your name, you can update the change through the Registrar’s office. The Student Health Center receives official student information directly from the Registrar’s office, so you would update your information through the Registrar’s office. 

More details on how to update your information: 

Legal Gender Marker and Name Changes

We can help complete the necessary paperwork for name and gender marker changes for driver’s license, passport, social security number and other documents.  

Gender Marker Change Without Surgery or Hormones

Some people live as their authentic gender without hormones or surgery.  It can be just as important to change legal documents to match their authentic gender.  It is not necessary to take hormones or have surgery to make these changes. Please make an appointment with a provider who has experience in Trans and Non-binary Care to discuss this. 

Mental Health Support 

Having a therapist who can support you through your transition can be extremely helpful. Therapy can also help students have a healthy relationship with their families as they transition.  We encourage students to consider therapy; however, this is not a requirement. CAPS offers short-term LGBTQ+ focused therapy and works closely with a community of off-campus therapists who can provide open ended therapy to support people with their gender journey.

Another important source of support for gender transition is the Lionel Cantu GLBTI Resource Center.  The resource center offers one-on-one check ins, weekly support groups, social connections, and community building. The Cantu Center also employs a Trans Education Specialist who is a source of all kinds of good information and support. You can contact the Trans Education Specialist, Ky Valentin Borunda, Pronouns (He/Him) at kborunda@ucsc.edu as well as at 831-275-2623.

Advocacy and support services are available for trans and nonbinary students who are survivors of sexual assault, who are currently experiencing partner violence or who are experience sexual harrassment or stalking. Visit the CARE website to learn more and make a confidential appointment if you choose.

Insurance and Financial Assistance

What does UC SHIP cover?

The student health insurance plan (UC SHIP) has many benefits for gender-affirming care.

UC SHIP is a comprehensive health insurance plan for students seeking gender-affirming care. All students are automatically enrolled in UC SHIP unless they waive it with proof of other insurance coverage. Financial Aid is available to cover UC SHIP for qualifying students. Get the details on UC SHIP.

Your coverage may vary depending on whether UC SHIP is your primary or secondary insurance plan. If you have two health insurance plans, your primary insurance remains your primary and UC SHIP is your secondary insurance (with some exceptions: MediCal, Medicaid, Tricare, and Medicare). It's important to know this when you're getting care off-campus (e.g. surgeries or other procedures).

For more information or questions about your insurance benefits please send an email to insure@ucsc.edu.

If I don't have UC SHIP, can I still access these services?

A student without UC SHIP can pay for in-person care, telehealth, labs, etc. out-of-pocket. Please talk to one of our team members and they'll help you review your options.

I’m graduating soon, what important information should I know?

To develop a plan for how you can continue to get hormone replacement therapy or other services after you graduate, make sure to schedule an appointment with your health care provider and case manager Lain Lease one to two months before you graduate. Your health care provider can prescribe refills for up to three months after graduation. Lain Lease can review insurance coverage and prescription options after graduation.

You can voluntarily purchase UC SHIP insurance coverage after graduation for one additional quarter if you had UC SHIP in your last quarter.

Students who have UC SHIP coverage and graduate in Spring will still be covered by UC SHIP through the end of the current academic year. To voluntarily enroll in and purchase UC SHIP, complete the Continuation Voluntary Enrollment form:

What financial assistance is available?

Various sources of financial assistance are available:

For information about additional resources, please contact Lain Lease.

Transgender and Nonbinary Care Team

Our Transgender and Nonbinary Care Team is dedicated to providing gender-affirming care. We are here for our Slugs!

The Transgender and Nonbinary Care Team

Student Health Center Team

Lain Lease headshot
Lain Lease, L.M.F.T.
Lain/They/He/She
Focus Areas:
  • case management services
  • transgender and non-binary care coordination
  • health insurance navigation
  • sexual and gender identity development
  • social justice and student activism
  • anxiety and panic
  • neurodiversity
Rayette Andrews

Rayette Andrews, RN (aka Nurse RayRay)

They/them

Focus Areas:

  • self-injection training
  • medical supply information
Dr. Sandy Lai headshot

Sandy Lai, MD

She/her/hers

Focus Areas:

  • trans and nonbinary medical care
  • hormone replacement therapy
  • STIs
  • contraception
  • sexual health
  • PrEP
Drew Malloy

Drew Malloy, MD

He/him/his

Focus Areas:

  • trans and nonbinary medical care
  • hormone replacement therapy
  • STIs
  • contraception
  • sexual health
  • PrEP

Additional Resources

Ky Valentín Borunda

Ky Valentín Borunda

Trans Education Specialist at the Lionel Cantú Queer Center

He/Him/His

Focus Areas:

  • identity exploration
  • navigating coming out
  • wellness planning
  • accessing HRT
  • career development
  • referrals to other support services

You can reach Ky by scheduling a Zoom meeting here, emailing  kborunda@ucsc.edu, or calling/texting 831-275-2623.

Ali Hayes

Ali Hayes, MPH

Senior Health Educator at SHOP

She/Her/They/Them

Focus Areas:

  • safer sex
  • pleasure
  • healthy relationships
  • PrEP
  • STIs
  • contraception

Amber Parker

Amber Parker

Health Educator at SHOP

She/Her/They/Them

Focus Areas:

  • safer sex
  • pleasure
  • healthy relationships
  • PrEP
  • STIs
  • contraception
  • alcohol and drug harm reduction

Questions

For additional questions about our program, please contact:

  • Lain Lease, Clinical Case Manager at (831) 459-1476
  • Sandy Lai, Associate Medical Director at (831) 459-1275