Trans student denied coverage for hormone therapy says policy is 'rooted in transphobia'

When Memorial University student Jiya Chandan learned her insurance provider doesn't cover the medication she requires as a transgender person, she didn't think too much of it.

But her perspective changed when the lack of coverage was questioned by her doctor.

"I realized that this is not right, that this is something that I wouldn't have thought about because I'm so used to these barriers, but it's not okay," said Chandan.

Chandan enrolled at MUN as an international student from India to study political science and has been taking hormones for almost three years.

The medication is a combination of testosterone blockers and estrogen supplements taken by many transgender people.

While Chandan was enrolled in Green Shield Insurance, which is offered to a majority of MUN students, about 70 per cent of the medication costs were covered.

But only students with a valid MCP can enrol in Green Shield.

When Chandan's MCP expired, she was forced to switch to Guard Me, the insurance provider used by many international students at MUN.

Now Chandan has to pay the full cost of the therapy — about $70 every month — herself, something she hasn't always been able to do.

"I've had to skip doses or I've had to make a month's dose last for two months by taking it every alternate day," said Chandan.

"It's not ideal to do. There can be adverse risks to your body, but those are just risks I have to be willing to take because I would rather have partial hormone medication than none."

Mackenzie Broders is the trans student representative with the Canadian Federation of Students in N.L.

Broders says it is "shocking" to hear that Chandan doesn't have adequate access to hormone therapy.

"Gender-affirming health care in all forms should be covered, especially hormone therapy," said Broders.

"It's often the most accessible and the first accessible form of health care to trans individuals. And so having that coverage by all health insurances … it's absolutely essential, and there's no excuse for why it isn't covered."

Hormone therapy, says Broders, is crucial for many transgender people as it alleviates gender dysphoria.

"It's often not only life-changing but life-saving," said Broders.

"It's not something that would be difficult to cover. It is something that is very accessible and the barriers that are in place around it are not necessarily necessary."

According to Planned Parenthood, gender dysphoria is "the distress, unhappiness and anxiety that transgender people may feel about the mismatch between their bodies and their gender identity."

And that's how Chandan felt while stretching out her medication.

"Discrepancies in how I feel about my body and how I would like to feel about my body," said Chandan.

"I could see that more masculine aspects of my body were starting to be visible that I had not seen for the last year and a half when I was on my complete dose."

When it was time for Chandan to repurchase the insurance three months ago, she contacted Guard Me with the help of MUN's Internationalization Office — and following the insurance provider's response, opted out.

In an email to the office, Guard Me said, "The policy covers Medically Necessary services required to treat eligible medical conditions. Transitioning treatments such as hormone therapy does not meet the eligibility criteria as it's considered to be elective."

Chandan calls the wording "painful."

"They call it an elective procedure when for a lot of trans people, access to hormones can be lifesaving," said Chandan.

"It's really disheartening to see that, and it seems like the policy is rooted in transphobia to an extent."

The insurance policy, says Chandan, is concerning.

"Why [does] a major insurance provider that acts as an insurance provider for a vast majority of international students across Canada not provide transgender health-care coverage to people?" said Chandan.

According to Guard Me's website, it's "a leading provider of international student health insurance." Guard Me did not respond to interview requests from CBC News.

But Chandan is also critical of eligibility criteria for the provincial MCP.

"If you have like eight months [in your studies] left and your MCP expires, there's a lot of times they'll just outright refuse to renew it," said Chandan.

"There's a large gap of students who are without MCP. And more so than students, a lot of people who go into the workforce, international students after graduating.… That is definitely something that raises concerns."

Health Minister John Haggie wasn't made available for an interview.

In an email sent more than a week after CBCs request, the health department replied with an outline of MCP eligibility rules.

Broders agrees with Chandan that trans health-care is an area that needs improvement on and off the campus.

"Here in the province, it's extremely difficult to access a lot of gender-affirming care, and there are only certain doctors that will even prescribe hormone therapy. And of course, you need an MCP card to see many of them," said Broders.

"It's difficult for people of all genders and orientations to access the care that they need just across the board."

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