Sexual and Reproductive Health

General Concerns

We provide a full range of services, including those listed below. Urgent concerns are seen on a same-day basis in our Walk-In Clinic. Students can make an appointment for non-urgent concerns. The Center for Awareness, Resources and Education (CARE) at Tufts also provides a wide range of educational information about Sex Health on their website.

Visit the Center for Awareness, Resources and Education (CARE)

  • Care for people who’ve experienced sexual assault
  • Birth control/Contraception
  • Emergency contraception
  • Evaluation and treatment of acute or chronic vaginal, anal, testicular or penile concerns/symptoms/trauma
  • Screening, treatment, and prevention of sexually transmitted infections
  • Annual examinations including breast/chest exam and Pap test
  • Counseling regarding both planned and unplanned pregnancy
  • Evaluation and treatment of testicualr pain or lumps
  • Treatment for urinary tract infections, genital warts, and many other issues.

Birth Control and Emergency Contraception

What methods of Birth Control are available to me?

We provide consultation about various contraceptive methods including pills, the NuvaRing (vaginal contraceptive ring), IUDs (Intrauterine Devices) and Nexplanon (the implantable rod).  While we don't insert Intrauterine Devices (IUDs) or Nexplanon (the inplantable rod) in our office, we can give you information on local providers who do.  

What is Emergency Contraception (also known as EC)?

Emergency Contraception (EC) is a safe way to prevent pregnancy after unprotected sex. EC is available whenever Health Service is open by coming to our Walk-In Clinic. Two types of EC are available at Health Service: Plan B and Ella.

If you have questions about EC when Health Service is closed, call our nurses advice line: 617-627-3350.

For more information and resources related to birth control, contraception, and gynecologic health, visit the CARE website.

Visit the CARE website

HIV Testing, Prevention and PrEP

HIV Testing

We provide confidential HIV testing. We do not share test results with anyone, not partners or parents, except as mandated by state law.

Make an appointment for routine screening or utilize our Walk-In Hours any time if you are worried about a symptom or have been exposed to someone diagnosed with HIV.

About Post-Exposure Prophylaxis (PEP)

PEP is medication that should be taken as soon as possible AFTER a high-risk exposure to reduce the chance of acquiring HIV. It needs to be started within 72 hours of a possible exposure, and ideally within 24 hours. Typically you will need to take a combination of three medications for 28 days.

Most insurance, including Tufts student health insurance, covers the cost of PEP. You will be responsible for the co-pays.

If you are concerned about a risky sexual exposure, come to our Walk-In Center as soon as we open the next day. If the next day is a Sunday (when Health Service isn’t open), you can call 617-627-3350 and follow the prompts to reach our nurse line.  The nurse can connect you with the clinician on call, if needed. 

About Pre-Exposure Prophylaxis (PrEP)

HIV PrEP is a medical treatment to protect you from HIV infection. PrEP is for people who are not HIV positive but are at high risk of infection. PrEP combines two medications in a single pill that is taken once a day for a period of months or years to prevent HIV. It is highly effective if taken very consistently.

Most insurances, including Tufts student health insurance, cover the cost of medications for PrEP.  We will help you connect with patient assistance programs that will cover the co-pays, so that PrEP will be available to you without any out of pocket expense.

If you are interested, make an appointment at Health Service to speak with one of our clinicians. Tell the appointment secretary that you want to discuss PrEP.

Fees and Insurance

Fees vary for different tests. Student health insurance and many private health insurance policies cover STI testing. We will work with you to see if your lab charges can be billed directly to your insurance company.

For more information and resources related to HIV Testing and Prevention, visit the CARE website.

Visit the CARE website

LGBTQIA+ Healthcare

Health and Wellness welcomes and affirms students of all gender identities, expressions, and sexual orientations. Our staff has been trained in LGBTQIA+ health issues. Our approach to health and sexual health is inclusive. Please come and see us!

Trans Health Care

The offices of Health Service and Counseling and Mental Health Service offer a range of services for trans, non-binary, and/or gender non-conforming students. Though all our staff are trans affirming, several staff in each office have received specialized training working with trans/non-binary people. Our forms and electronic medical records offer you the opportunity to self-identify your common name, gender identity and pronouns.

Contact us to:

  • speak with a clinician/provider specially trained in trans health care
  • initiate or continue the prescribing of hormone treatment
  • receive information about gender affirming surgery

Call 617-627-3350 to make an appointment with Health Service or 617-627-3360 to make an appointment with Counseling and Mental Health Service.

For questions about insurance and billing, please contact the Health Service Business Office

Gender Affirming Hormone Treatment (GAHT)
I’m interested in starting Gender Affirming Hormone Treatment (GAHT)

The offices of Health Service (HS) and Counseling and Mental Health Service (CMHS) support trans and non-binary students who are wishing to feel affirmed in their gender. We aim to follow the standards of care developed by the World Professional Association of Transgender Health (WPATH). With respect to Gender Affirming Hormone Treatment (GAHT), CMHS coordinates care with HS. This includes a discussion about potential mental and medical health-related concerns that may interact with the effects of hormone treatment.  We aim to make this process as smooth and quick as possible. The timeline varies case by case. These steps and projected timelines are approximate to help with planning and preparing.

The first step is to start with an appointment with a CMHS clinician. Please see tab below for more specific information.

If you are already being seen at CMHS for counseling:

Please speak with your therapist and inform them about your desire to pursue hormone treatment. In some cases, you may be referred to meet with another clinician for a brief evaluation.

If you are already connected with a provider at HS:

Please notify your provider that you are interested in pursuing hormone treatment. Your provider will refer you to CMHS for a brief evaluation.

If you are already taking hormones:

Health Service can help you monitor your hormones and/or manage your prescriptions while you are at Tufts and will coordinate care with your other prescribing provider as needed/if appropriate.

 

First Step: Meet with a CMHS Clinician

First: Meet with a CMHS clinician

  1. Call CMHS at 617-627-3360 and ask to be scheduled for an intake appointment with a trans care specialist. Note: Though all our providers are trans affirming, several have received specialized training in providing trans-related care.
     

The following CMHS clinicians are part of the trans care specialist team:

All Tufts/SMFA Students
  • Megan Tucker
  • Michelle Chen 
  • Ritu Sharma
  • B. Francis Chen
SMFA Dual Degrees Students Only
  • Maria Hiraldo
  1. You’ll meet with the clinician for approximately 2-3 appointments to discuss the following:​
  • Mental health history
  • Key aspects of your gender identity and history
  • Your hopes for GAHT and anticipated barriers
  1. Prior to your initial appointment at HS, your CMHS clinician will collaborate with your HS provider. The following information will be provided:
  • Demographic and identifying information
  • Nature and length of your work with the CMHS clinician
  • A statement that the following criteria are met: 1) 18 or over, 2) Presence of gender dysphoria, and 3) Upon evaluation, student appears to be appropriate for referral to HS for a discussion about GAHT.
  • Other relevant information that will help in providing you with the best care
  1. Optional: Though not a requirement, some students may decide to pursue ongoing counseling.  CMHS offers brief therapy and can also assist a student with a referral to a local provider.
Next Step: Referral to Health Service (HS)
  1. Call HS and indicate that you’d like to schedule an appointment to begin hormones. Note: Though all our providers are trans affirming, some have received specialized training in providing trans-related care.

You’ll be scheduled for an appointment with one of the following trans care specialists:

  • Margaret Higham
  • Stacey Sperling
  • Ariel Watriss
  1. You’ll meet with the medical provider for approximately 2-3 appointments:

Appointment #1: Discussion of your medical history

  • Relevant discussion of your gender identity and history
  • Creating a roadmap of your hopes and goals for treatment
  • Review hormone effects, dosing timelines, possible complications, & consent forms
  • Answer questions you may have

Note: After this appointment, you’ll be asked to complete relevant lab work.

Appointments #2 - 3

  • Review lab work
  • Physical exam (generally clothing on unless there are specific health-related questions)
  • Solidify a comprehensive understanding of your health history, including a discussion about possible contraindications
  • Answer follow-up questions about hormones and sign consent document
  • Review the medication (i.e., initial dosing and management of dosing over time, how medication is obtained and how it is taken)
  • Answer questions you may have
  1. When you and your provider decide together that moving forward with HRT makes sense for you, you’ll receive a prescription to begin. Please see "Medications for Gender Affirming Hormone Treatment" tab below for more specific information related to gender affirming hormones/medications.

Additional appointments

  • Some students may be offered additional appointments related to various medical concerns, for example, if you need more support around receiving injections.
  • After beginning hormones, you’ll work in an ongoing fashion with your provider for routine follow-ups, usually scheduled at one, three, six, and 12 months.

*Note: There are sometimes contraindications that might necessitate a 2nd opinion or a more experienced provider’s care from an outside organization. In these situations, CMHS and HS are aware that students may experience a range of emotions related to the request for a second opinion.  We will do our best to support students through this process.

Medications for Gender Affirming Hormone Treatment

Most insurance plans in Massachusetts cover gender affirming hormone medication the same way they cover other medications: insurance covers most of the cost, and the member covers a copay.  The exact co-pay is set by the insurance plan and varies from plan to plan.  In addition, many insurance plans have a “deductible” that can significantly impact the cost of your medications.  This is an amount that the member pays out of pocket, before the insurance benefits become active.  The deductible can be any amount, but is often between $1,000 to $6,000.  So it can be difficult to determine what the student’s out of pocket expenses will be without knowing a lot about the insurance plan.  We can help you understand your insurance at our Business Office in Health Service – just call the main number at Health Service, 617-627-3350, and listen for the prompts.

Before starting hormones or medication, your health care provider will talk with you about medication effects, side effects, what to watch out for, and what dose to use, depending on your goals and medical history.  Below is some basic information about the commonly used medications and hormones.

Feminizing Hormones/Medication: 

  • Two medications are given for feminization—Estrogen and Spironolactone 
  • Estrogen is a hormone that comes in pill form, as an injection, or as a patch.  Most adults under 35 take the pill form twice a day.  
  • Spironolactone is an “androgen blocker” that helps suppress testosterone levels.  It comes in a pill form and is usually taken daily twice a day.
  • Estrogen and spironolactone are readily available in any pharmacy.

Masculinizing Hormones:

  • Testosterone is the masculinizing hormone. 
  • Testosterone comes in many forms:  injection, patches, gels, and implants.  Since patches, gels, and implants are expensive and difficult to deal with, most people use injections.  
  • Injections are given either once a week or every two weeks. 
  • We recommend that Testosterone be obtained from pharmacies that have special expertise—Health Service commonly works with New Era Pharmacy in Portland Oregon which ships directly to you.
  • At New Era, a 10 ml bottle of Testosterone lasts for 9 months or more depending on your dose, and costs $65 out of pocket, which is much cheaper than using your insurance. 
  • Prescriptions for needles and syringes will also be needed.
  • Our nurses will work with you to help you learn to administer your injections.
  • We will also provide you with a small sharps container for safe needle disposal.
Gender Affirming Surgery (GAS)
I’m interested in receiving a referral letter for gender affirming surgery (GAS)

The offices of Health Service (HS) and Counseling and Mental Health Service (CMHS) support the gender affirmation of trans and gender non-binary students. We follow the standards of care developed by the World Professional Association of Transgender Health (WPATH). Our staff recognizes that many trans and gender non-binary students face barriers in healthcare, including the steps for seeking insurance coverage for gender affirming procedures. We assist students in making this process as smooth and quick as possible. While the actual timeline varies case by case, these steps and projected approximate timelines are offered to help with planning and preparing.

The first step is to schedule an appointment with a CMHS clinician. Please see tab below for more specific information.

If you are already being seen at CMHS for counseling:  Please speak with your therapist and inform them about your desire to have an evaluation for a gender affirming surgery referral. In some cases, you may be referred to meet with another clinician for this evaluation.

If you’re connected with a provider at HS: Please notify your provider that you are interested in receiving an evaluation for a gender affirming surgery referral. Your provider will refer you to CMHS for that evaluation.

First: Meet with a CMHS clinician

1)      Call CMHS at 617-627-3360 and ask to be scheduled with a trans care specialist for a gender affirming surgery eval. Note: Though all our providers are trans affirming, several have received specialized training in providing letters and other trans-related care.

The following CMHS clinicians are part of the trans care specialist team:

All Tufts/SMFA Students
  • Megan Tucker
  • Michelle Chen 
  • Ritu Sharma
  • B. Francis Chen
SMFA Dual Degrees Students Only
  • Maria Hiraldo

 

 

 

 

    2)      You’ll meet with the clinician for a minimum of 2-4 appointments to discuss the following:

  • Mental health history
  • Key aspects of your gender identity and history
  • Related to the surgery

             i.      What surgery you are hoping to have
             
ii.      Your hopes, expectations, and worries about the procedure
             
iii.      Reviewing your plan and preparing for before, during, and after the procedure, including a discussion about your social supports
             
iv.      Your understanding of the psychological/emotional impact of some of the risks, possible complications, and outcomes of the surgery

  • If/when the letter is written, reviewing it together before faxing to the surgeon (with a release of information)

3)      When a referral for surgery is made, the clinician will prepare a letter for the surgeon’s office. It will include the following elements:

  • Your general identifying characteristics
  • Results of the psychosocial assessment, including diagnoses
  • Duration and type of evaluation/counseling with the clinician
  • Indication that the criteria for surgery have been met (see below), as well as a description of the rationale for supporting your goal for surgery
  • That you are capable of consenting to treatment
  • That the clinician is available for coordination of care via phone
  • Additional relevant information that helps to communicate to the surgeon and subsequently the insurance company your need and appropriateness for surgery

Optional: Though not a requirement, some students may decide to pursue ongoing counseling.  CMHS offers brief therapy and can also assist a student with a referral to a local provider.

Requirements for Surgery

The following are the requirements for surgery outlined by WPATH. Not all surgical procedures are listed, and insurance companies often have their own set of guidelines that are adapted from these requirements. Surgeons may have additional requirements for their own practice as well.

Requirements for Upper/Top Surgery

  1. Persistent gender dysphoria
  2. Ability to make a fully informed decision & consent to treatment
  3. 18 years or older
  4. Reasonably well managed mental health/medical concerns (if present)

Note:

  • Typically, one letter of referral is required.
  • Though hormone treatment is not an explicit requirement through WPATH, some insurances require it or ask for an explanation if the person has decided not to use hormones.
  • For double mastectomy/chest reconstruction, it is recommended that the person be on hormones for at least 12 months to allow for maximum redistribution of fat and potential muscle development.  
  • For augmentation/mammoplasty, it is recommended that the person be on hormones for at least 12 months to maximize breast growth.

Requirements for Lower/Bottom Surgery

  1. Persistent gender dysphoria
  2. Ability to make a fully informed decision & consent to treatment
  3. 18 years or older
  4. Reasonably well managed mental health/medical concerns (if present)
  5. 12 continuous months of hormone treatment (unless medically contraindicated)
  6. For metoidioplasty, phalloplasty, and vaginoplasty procedures, 12 continuous months of affirmed gender expression*

Note:

  • Typically, two letters of referral are required for these procedures.

*CMHS and HS recognize that gender expression looks a variety of ways for people of all genders and considers whether that person is expressing in a way that feels affirming for their own identity and sense of self.

Things to Consider
  • CMHS recognizes that many students have been thinking about and researching this procedure for quite some time and may already know which surgeon they’d like to work with. Regardless, we’re open to helping you look at your options to make the best decision for you.
  • If you have chosen your preferred surgeon, please take note of the surgeon’s requirements and how they are similar/different than those of your insurance company.
  • Because your insurance company requirements may be different than those of WPATH, you are encouraged to call the insurance company or search for the document that clarifies which procedures are excluded (i.e., this document may be called the coverage determination guidelines or medical coverage policy) to find out the requirements for gender affirming surgery.
  • Some insurance companies require at least one of the letters to be written by a doctoral level clinician. If yours has such a requirement, CMHS will do our best to accommodate you.
  • If you already have received a letter from another provider/clinician and are seeking your 2nd letter, your CMHS clinician may ask to coordinate care with that other provider or to see the referral letter that the person has written for you.
  • Further down on this web page, please see For Ongoing Support and Other Healthcare Resources for additional campus resources, information about name change, and off campus resources/web pages.  
Resources for Surgery

General Resources

Trans Masculine Procedure Resources

Trans Feminine Procedure Resources

 

Additional Information
Trans Health Care Specialists

Though all our providers and clinicians at Health Service and Counseling and Mental Health are trans affirming, several have received specialized training in providing trans-related care. 

The following providers are part of the trans care specialist team: 

Health Service

Margaret Higham, MD
Stacy Sperling, MD
Ariel Watriss, NP

Counseling and Mental Health Service

All Tufts/SMFA Students
Megan Tucker
Michelle Chen
Ritu Sharma
B. Francis Chen
SMFA/Dual Degree Students Only
Maria Hiraldo

Call 617-627-3350 to make an appointment at Health Service and 617-627-3360 to make an appointment with Counseling and Mental Health Service. 

 

Insurance Coverage

The Tufts University sponsored student health insurance plan is provided through UnitedHealthcare StudentResources. This policy covers a full range of transgender health benefits including gender affirmation surgeries, hormones and counseling.

Exclusions: The following are not covered:

  • Facial Feminization surgery, including but not limited to: facial bone reduction, face "life", facial hair removal, and certain facial plastic reconstructions.
  • Reversal of genital surgery or reversal of surgery to revise secondary sex characteristics
  • Cryopreservation of fertilized embryos
  • Sperm banking
  • Voice modification surgery and voice therapy
  • Rhinoplasty (except if criteria is met)
  • Belpharoplasty (except if criteria is met)
  • Abdominoplasty (except if criteria is met)
  • Surgical or hormone treatment on enrollees under 18 years of age
  • Surgical treatment not prior authorized by UnitedHealthcare
  • Drugs for hair loss or growth
  • Drugs for sexual performance for patients that have undergone genital reconstruction
  • Drugs for cosmetic purposes
  • Hormone therapy except as described in the Covered Services section.
  • Other exclusions may apply. Check the plan-specific documents before making a determination.

We recommend you come in to the Health Service Business Office, or give us a call at 617-627-3350 if you have any questions about coverage.  Although surgeries and hormones are covered, there are co-pays and out-of-pocket costs associated with all medical care (i.e., the coverage limit does not mean you will not incur any costs).

Medical Record Documentation
  • The Tufts Health Service Pre-entrance Health Questionnaire will ask for both sex at birth, and your gender identity.
  • Your medical record however, will reflect the sex that is entered into the Student Information System.
  • If the name you use is different from your legal name, tell your clinician – we can manually enter this name into your medical record. Both names will show up in your medical record. Please review the steps provided here for a Preferred Name Change. We can also enter your preferred pronouns into your medical record.
For Ongoing Support and other Healthcare Resources

While seeking gender affirming treatment can be very exciting, the process can also feel stressful so having support will be important. In addition to short-term individual counseling at CMHS and LGBTQIA healthcare at HS, students also have access to many other supports including Trans at Tufts and other CMHS groups, as well as many discussion and peer facilitated support groups offered by the LGBT Center on Campus. If you’re seeking ongoing counseling and support, you can schedule an appointment with a CMHS Case Manager to help with referral. If you are experiencing any financial concerns/barriers, please don’t hesitate to ask your provider about possible options for support/assistance. Please see additional resources below.   

Tufts Health and Wellness Resources

Queer and Trans Healthcare, STI testing, and HIV Care/PrEP

CMHS Short-Term Counseling

CMHS Groups, including Trans at Tufts

Ongoing/Long-term Counseling - Help with Referral

Tufts LGBT Center

LGBT Center homepage

Groups and Programs through LGBT Center

Team Q Peer Leader Program

Join the LGBT Center Listserv

Name Change

Update Common Name at Tufts
Legal Name Change at Tufts
Legal Name Change in Massachusetts
Name Change in Other States
Free Legal Help through GLAD

Additional Campus Resources

List of ‘All Gender’ Restrooms on Campus

Rainbow House - Special Theme Housing

Housing for Trans/NB Students

Career Resources

Study Abroad

Student Accessibility Services for Accommodations

Tufts Non-Discrimination Policy

Off Campus Healthcare Resources

Though all students who pay the student health fee are eligible for services, some students may prefer not to seek gender affirming treatment at Tufts University Health and Wellness. The following local health centers also provide care, though wait times for an appointment may vary and costs may depend on your health insurance coverage.

Fenway Health

Sidney Borum Jr. Health Center (same day appts, ages 12-29)

Boston Medical Center - Trans Medicine

Boston Childrens Hospital - GeMS Clinic

Additional Web Resources

Trans Care Site - search for trans affirming services/providers

WPATH - Standards of Care/Guidelines for Trans Healthcare

Mass Transgender Political Coalition - many supports and services

Freedom MA - Yes on 3 in November against trans discrimination

National Center for Trans Equality

STI Testing

Screening can be important for anyone who is sexually active and Health Service provides routine sexually transmitted infection (STI) testing. 

  • Utilize our Walk-In Hours if you are worried about a symptom or have been exposed to someone diagnosed with an STI. 
  • We offer three ways to get routine STI testing for anyone that do not have any symptoms and have not been exposed to someone diagnosed with an STI: 
  1. Traditional: Call 617-627-3350 to schedule an appointment and meet with a clinician
  2. OnLine Scheduling: Schedule an appointment online to meet with a clinician
  3. Self-Testing Method: No appointment with a clinician. You complete the evaluation process online. If you qualify, the clinician sends an order to the lab
  • Important: In order for the STI test to be accurate, patients are asked to not urinate within 1 hour of the test.
  • Bring your insurance card with you to pay for the testing. If you would like to "self pay", please let our lab staff know.
  • For more information and resources related to STIs and Testing outside of Health Service, visit the CARE website.
Traditional Method

Call 617-627-3350 to make an appointment with one of our clinicians.

OnLine Scheduling

Make an appointment online to meet with one of our clinicians using the following steps: 

  • Log into the Patient Portal
  • Go to the Appointments tab
  • Under "Reason" select: STI/HIV Testing- Provider Visit Incuded
  • Click Submit
  • Select a date and time for the appointment
Self-Testing Method

This process allows you to get testing without seeing a clinician. You navigate the process online with minimal interaction with our office.

  • This testing process does not include testing for syphillis or anal infections. If you need these tests, please schedule an in person appointment.
  • You can use this process to obtain urine or vaginal testing for Chlamydia and Gonorrhea, and blood testing for HIV.

To start this process, please follow the steps below:

  • Log into the Patient Portal
  • Go to the Forms Tab
  • Complete and submit the STI Self-Test Questionnaire

Once the student receives the secure message from the clinician stating the orders have been placed at the lab:

  • Log into the Patient Portal
  • Go to the Appointments Tab
  • Under "Reason" select: STI Self Testing- AFTER Online Questionnaire completed
  • Click Submit
  • Select a date and time for the lab appointment