Trans and Gender Diverse Health

UHS offers gender-affirming hormone therapy (GAHT) in an informed consent model. UHS does not require a student to get a letter from a mental health provider in support of hormones as long as they can provide informed consent for care. A student can provide informed consent if they:

• Have correct information about GAHT
• Are able to understand the GAHT information provided includes risks and benefits, as well as reversible and irreversible effects
• Are able to use this information to make a decision**

The informed consent model is consistent with WPATH Standards of Care and reduces barriers to accessing medically necessary treatment. In this model, students are given accurate and comprehensive information about GAHT, and will be supported in making the right decision for them. Providing care in an informed consent model does not mean that hormones are available on demand. If a medical provider determines that a student seems unable to provide informed consent, a student may be referred to Mental Health Services for further evaluation. An example of when a student may not be able to provide informed consent is if they experience acute psychosis related to gender.

Five UHS medical providers are trained to provide care related to gender affirming hormones, including initiation and maintenance. Providers who offer care GAHT-related are:

Erika Enk, CNM, MPH

Megan Gendel, APNP, FNP-BC

Elaine Hirschfield, MD

Amy J. Lasch, PA-C

**language from Howard Brown Health

1. Book an initial TGD appointment on MyUHS. Or call the Primary Care Clinic at 608-265-5600 (option 1). Ask to schedule an appointment to begin hormones.
2. You and your provider will create a care plan, discuss your medical goals, provide informed consent, and complete labs as directed.
3. Attend a follow-up medical appointment with your provider where you will review labs results, discuss potential medical contraindications, and, if appropriate, receive a prescription for GAHT.

Ongoing work with you medical provider and follow-up care will continue. Follow up appointments are routinely scheduled at one, three, six, and 12 months.

UHS understands that stress related to discrimination impacts your well-being and can exacerbate anxious and depressive symptoms. If you experience distress, we encourage you to talk with your medical provider to learn about options for gaining additional support. UHS offers individual and group counseling with providers who have extensive experience working with TGD students, can prescribe medication if appropriate, and has many wellness and stress reduction offerings.

Transitions can be stressful and having support will be important. In addition to what is offered at UHS, students also have access to community-based supports including discussion and peer facilitated support groups offered by the Gender and Sexuality Campus Center and OutReach LGBT Community Center.

University Health Services (UHS) is committed to providing surgical readiness letters at no cost to students.  

If you are already connected with a Mental Health Services (MHS) provider, you can request a letter from your current provider. 

If you have not established care with UHS or do not have an MHS provider, letter writing appointments are available in a single-session format and will not require ongoing counseling services. Letter writing appointments will be done in a single appointment, unless you have additional questions/concerns or are seeking additional resources. There are two ways to schedule with an MHS provider to discuss getting a letter in support of surgery:

• Log in to MyUHS or the MyUHS app and schedule an appointment
• Call 608-265-5600 (option 2)

During your appointment, your mental health provider will conduct a psychosocial assessment to gather information needed for the letter of support as required by surgeons and insurance providers.   

Many surgeries require a recovery period. Our mental health providers will work with you to help build and support your resilience in preparing for any post-surgical needs you may have. 

Before your letter writing appointment, your MHS provider will need:

• Insurance carrier 
• Name of medical facility or provider will be conducting your surgery consultation 

At your letter writing appointment come prepared with:

• Your plan for social support and post-surgical care  

We understand why many TGD students want to work with mental health providers who have experience and training in gender identity and expression. Whether you want support in your exploration of gender identity, you experience symptoms of anxiety or depression, or have other concerns; Mental Health Services has providers who offer care in an affirming way.

UHS has providers with a designated focus and in-depth experience working with TGD students & LGBTQ students:

Blake Bettis
Annie Bruns
Alex Little
Mariessa Robles
Kari Treu

To meet with a UHS mental health provider, schedule an Access Appointment. During this consultation, tell the access specialist that you would like to receive care from a provider who has experience with TGD students. You may also request to work with a LGBTQ+ or TGD-identified mental health provider.

There are a number of campus and community-based support options for TGD students.

UHS Mental Health Services facilitates a weekly TGD Support & Empowerment group during the fall and spring semesters. Additional group offerings include weekly LGBTQ+ Support & Empowerment groups. Mental health providers facilitate these counseling groups. If you are interested in participating in a group, visit our Group Counseling page to learn more.

If you are interested in groups not affiliated with UW–Madison, visit OutReach LGBT Community Center to learn about other options and resources.

Certain identity documents require a physician letter to certify a change in gender or name. If your previous GAHT provider is not able to provide documentation, UHS can this provide for no cost for registered students.* You will need to establish care with a primary care provider who provides GAHT. The provider will need information regarding your “transition-related treatment.”** Usually one to two office visits and a review of outside medical records from your past GAHT-provider will satisfy this requirement.

Outside medical records can typically be obtained at no cost when they are transferred directly to UHS. You can start this process online prior to your first appointment:

1. Log into the “MyUHS” portal on our website
   2. Click on “Messages” on the left-hand side
   3. Click of “New Message”
   4. Check “I am a UW student or domestic partner”
   5. Check “I want to authorize RELEASE OF MY HEALTH INFORMATION”
   6. Complete the remainder of the form, electronically “sign” the form and click “Send”

*If you are not registered for classes over summer break, you will need to pay the one-time summer fee to access UHS care and services during the summer.

** Wording per the Transequality website’s nationwide database for identity documents:
See https://transequality.org/documents for details.

You can schedule a follow-up appointment or log in to your MyUHS account and send a new message directly to your current GAHT provider. Tell your provider what type of document and what state (if applicable) you need.

Completed letters are signed, placed in sealed envelopes, labeled with your name in use and date of birth, and available for pick up with a 5th floor receptionist during business hours (your provider will specify the specific desk when they message you to let you know the letter(s) are ready). Signed letters can be scanned into the medical record and shared electronically in your MyUHS account. Some students use this option if they are off campus.

If you face a deadline to complete a letter, schedule a visit with the next available GAHT provider. They can review your records and typically create the required letter(s).

Please note some letters require a doctor’s signature. If you see a physician’s assistant or nurse practitioner for your GAHT, they will consult one of the licensed physicians who provide GAHT to review your medical records and co-sign the documents.