In the early 1980s, a student at Harvard University who had been born a female but lived as a male gained the trust and support of a sympathetic university registrar. Each semester, the campus official would ask the student to provide a list of the classes he’d signed up for. The registrar made sure that every class list showed the student’s preferred name so as to save him the embarrassment of publicly revealing his biological gender.
Today’s transgender college students still need the same compassion, says Norman P. Spack, a pediatric endocrinologist at Boston Children’s Hospital who is best known for helping children change their gender. Colleges, he said, are likely to encounter transgender students like his former patient, the Harvard student, at a critical juncture in their lives. Understanding what those students have already experienced—and what they’re likely to encounter on the college campus—will help practitioners care for them more effectively, he said.
“You may not know who they are or where they are. You may not know anything about them,” Dr. Spack told a packed room of college-health professionals here on Friday at the American College Health Association’s annual meeting. Yet despite the complexity of the issues, he said, “There’s no greater thrill than to help people be who they are.”
The doctor’s comments come at a time of rapid change, as many colleges revamp existing policies and adopt new ones meant to deal with the needs of transgender students.
Many campuses now have gender-neutral housing. Some allow students to use a preferred name on ID cards and class rosters, or permit transgender students to change the gender designation on their primary college records without requiring proof of sex-reassignment surgery.
It is the question of whether student health insurance should cover sex-reassignment surgery, which changes a person’s physical characteristics to resemble the opposite sex, that has attracted the most attention in recent years. The Transgender Law & Policy Institute reports that more than three-dozen colleges, including the entire University of California system, now include the surgery in their student health-insurance plans.
Still, advocates say that colleges do not meet the basic health-care needs of transgender students, in part because practitioners lack training in how to help people who are questioning their gender identity or in the process of transitioning to the opposite gender.
Dr. Spack, who sees hundreds of children and adolescents in his clinic, advised the college practitioners here to be vigilant. Some transgender students, he said, come to college having already transitioned to the gender with which they identify. Sometimes they have support from parents and friends back home.
But he cautioned that many more begin college still smarting, in some cases severely, from years of emotional and physical trauma. In those cases, if parents have discouraged or restricted altogether a student’s gender dysphoria, students may have suppressed their emotions.
“And then they come to college, where gender nonconformity is everywhere,” Dr. Spack said.
‘A Normal Guy’
Joining Dr. Spack in the discussion was Skylar Kergil, a gregarious recent graduate of Skidmore College. Mr. Kergil was born female. In high school, he began transitioning socially to become a male. About eight months before arriving at Skidmore, he began taking hormones that would gradually transform his features.
At first, Mr. Kergil said, he had viewed going to college as an opportunity to start fresh. He didn’t want to talk about his experiences.
“I just wanted to be a normal guy,” he said.
But staying silent was painful and, to his surprise, caused even more anxiety than the prospect of explaining everything to his peers. At the end of his freshman year, Mr. Kergil decided to tell his close friends. The following year, he came out completely, to professors and acquaintances alike. “I was born a female and started transitioning in high school,” he would tell people. To his surprise, they took it well, and appeared enthusiastic about learning more.
Now, after graduating, he says being open about his experiences has had an “incredible” effect on his mental health.
In Mr. Kergil’s case, his parents supported his transition. But Dr. Spack said campus clinicians who see transgender students in the health center or the counseling center should bear in mind that, with transgender students, “parents aren’t always allies.” They might be angry, once the child leaves for college, that the student is no longer in their control, he said. They might feel guilty over how they responded in the past to their child’s confusion. They might wonder what damage has been done.
At the packed session, college-health officials peppered Dr. Spack with questions. Some queries were clinical, about, say, the proper administration of hormones to students transitioning to the opposite gender.
But many offered observations, or asked how to help. A mental-health professional at Ohio State University said she’d noticed a recent, subtle uptick in the number of international students who identify as transgender. A physician at Wake Forest University wondered how clinicians might screen students in a sensitive but effective way.
An official from the University of Michigan wondered whether new health-insurance exchanges would allow the university to customize its policy to continue including sex-reassignment surgery. (Another official, from Portland State University, said yes, it can be done.)
At Skidmore, Mr. Kergil said, progress came quickly. His first visit to the counseling center led him to a therapist who didn’t know how to help him. But he eventually went back and found one who did.
What matters for transgender students, he said, is simply this: “Knowing that they’re not going to be looked at with wide eyes and inexperience.”
Correction (6/6/2013, 3:08 p.m.): This article originally misidentified the transgender student who appeared with Dr. Spack at the meeting. He is Skylar Kergil, not another transgender student, also named Skylar, who was featured prominently in a long article this spring in The New Yorker about transgender children. Mr. Kergil was mentioned in a follow-up blog post by the author of the New Yorker article. This article has been updated to reflect the correction.
