(Part I of this story appeared on March 10, 2010.)

In an effort to foster a more inclusive campus community, Harvard is actively putting its policy into practice.

In accordance with the University’s non-discrimination policy, which was modified in 2006 to include gender identity, University Health Services decided to address the medical needs of transgender people with more equitable insurance coverage.

Each transgender person experiences the process of transition in a different manner—some prefer to avoid medical intervention and others seek the full range of possible treatments, from genital reconstruction to hair removal.

While Harvard’s insurance plan has covered sex hormones since 2006, a new policy adopted in January incorporates coverage for top surgery, meaning mastectomies for transgender men (women transitioning to men) and breast augmentation for transgender women (men transitioning to women).

While the change is greatly appreciated within Harvard’s transgender community, finding full treatment and acceptance from others remain significant challenges.

A HUGE EXPENSE

Prior to the change in the insurance policy, BlueCross BlueShield of Massachusetts—the supplementary health insurance plan for most Harvard affiliates—did not cover sex reassignment surgeries, even with a doctor’s recommendation.

“It’s a huge expense to try to come up with the money to afford surgery, so to have it covered through insurance is a big deal,” says Iain M. Stanford, who is working on a doctoral dissertation in queer theology at the Harvard Divinity School. “Personally, I could not think about surgery unless it were covered by insurance.”

Noah E. Lewis—a staff attorney for the Transgender Legal Defense and Education Fund who has been deliberating with UHS and the insurance company on the inclusion of transgender surgeries in Harvard policies—says that the previous exclusion meant that only the most economically privileged people could access these treatments.

“Transgender exclusions therefore deny medical coverage to the people who need it the most—people who are unable to afford care on their own,” says Lewis, a 2005 graduate of Harvard Law School.

A senior who identifies as a transgender man and asked to remain anonymous says he would not have been able to afford top surgery for several years without insurance coverage, so he did not feel it was worthwhile to begin treatment with the available hormones.

“For me, having top surgery is the key to being able to be perceived as the gender that I am; I could take hormones that would masculinize my face and my voice, but I still wouldn’t pass in public without the top surgery,” he says. “I thought I would have to delay changing my physical body until after I graduate and pay off my student loans, and that was really disheartening.”

Although he will graduate before the insurance begins coverage for students on Aug. 1 of this year, he says that he is thrilled that treatment for transgender people will now be covered.

“It’s going to make a real positive difference for students who come after me,” he says.