The Gender-Affirming Care Team (GACT) is honored to support you in your unique process of gender affirmation. We are here to connect you with resources, offer consultation, provide counseling, discuss non-medical affirmation and provide support around social transition. Additionally, the GACT can share opportunities for social connection and learning, provide information about name and gender marker changes, initiate or continue gender-affirming hormone therapy, and provide trans-affirming voice therapy. We recognize that the path towards gender-affirmation looks different for everyone and may or may not include gender-affirming hormones. GACT clinicians adhere to the World Professional Association for Transgender Health (WPATH) guidelines and evidence-based practices.
Let us know about your experience pursuing gender-affirming care! Submit feedback here or talk with a member of the Gender-Affirming Care Team.
Commitment to Accessibility, Diversity, Equity, and Inclusion
The Gender-Affirming Care Team along with Counseling, Health, and Wellness are committed to supporting the holistic health and well-being of all students. We understand that experiences of gender affirmation are informed by many aspects of identity and experience, including race, ethnicity, culture, ability, and religion. We are here to support you in reaching your personal gender affirmation goals in ways that respect and embrace all of who you are.
Supporting Social Transition & Connection
LGBTQ+ Western provides support and connection to resources, programming, and a website full of information. Their Trans Tea program happens the first and third Tuesdays of the month at 4pm. The Counseling and Wellness Center offers support and therapy groups, including Queer Connections. Students can use a lived name and indicate their pronouns at Western and you can change your name or pronoun with the Student Health Center through MyWesternHealth. Student-led opportunities for connection include the T.A.G. Team club and Queer Resource Center.
Survivor Support and Advocacy
Every person deserves to be treated with love, dignity, and respect, to be able to be their full selves and to be safe in their intimate and sexual relationships. Unfortunately, that is not what everyone experiences. When someone experiences violence and/or abuse, they deserve to be in control of the next steps, to be believed, and to be supported in their healing. If you or someone you know is experiencing/has experienced violence and/or abuse, on-campus support and resources are available.
Names and Pronouns
If you’d like to change your name or pronouns in our medical record system, we can easily update your electronic medical record in either the Health Center or Counseling & Wellness Center. You can also update your name or pronouns through MyWesternHealth. Information about changing your name as a student for class rosters, email, etc.) can be found on LGBTQ+ Western's Name Changes for Students page. You can indicate your pronouns in the Personal Information section of Web4U.
Sexual and Reproductive Health
Take charge of your sexual and reproductive health. Ask your Student Health Center provider about age-appropriate cancer screening, immunizations, and STI screening. If you have a cervix, pap smears for cervical cancer screening are recommended at age 21. Annual chlamydia screens are recommended for many. People using PrEP do STI screening every 3 months. Testicular cancer is most common ages 18-30; if you notice a mass in your testicular area, please seek evaluation.
Gender-Affirming Hormone Therapy
For students seeking support around mental health the Counseling and Wellness Center offers individual, group, and couples counseling along with a variety of wellness programs and workshops. Learn more about initiating therapy services.
Voice and Communication Training
As part of gender-affirmation, some individuals may pursue voice and communication training to align their speech more closely with their gender identity. Goals of speech and communication training are highly individualized and based on client preferences. Therapy often involves developing healthy voice practices to effectively and sustainably modify vocal pitch, intensity, resonance, and quality. Therapy also addresses other aspects of communication such as intonation, rate, rhythm, and nonverbal communication patterns to support self-expression that feels authentic and aligns with the client’s sense of self. Attention is also given to the social and emotional aspects of integrating these new communication patterns.
Currently, all new evaluations for voice and communication training are done through the WWU Speech-Language Clinic. Students seeking support in this area may also contact Catalyst Therapies or view other off-campus referral options listed in the FAQ section at the bottom of this page.
Western's Student Health Center is a primary care medical clinic specializing in college health. We are staffed by a team of board-certified family physicians, nurse practitioners, registered nurses, and support staff. In addition to gender-affirming hormone therapies, we provide an extensive array of services including preventive health care and management of health concerns, illnesses and injuries.
MyWesternHealth is your personal health information portal. It provides a way for you to review your health record and allows you to communicate with your provider in a secure, encrypted way.
Heather Whitaker, ARNP, FNP (she/her)
Family Nurse Practitioner
Heather Whitaker is a family nurse practitioner at WWU’s Student Health Center. Her passions include hiking, social justice, healthcare, baking, and speed crafting. She joins the Gender-Affirming Care Team to celebrate and support students’ self-discovery and wellness. Health care is a human right, and in this spirit, she commits to improving access to gender-affirming care, elevating the voices and experiences of students, and creating a welcoming space at the Student Health Center. She looks forward to meeting and working with you wherever you are on your gender journey.
Michele Tulk, PMHNP-BC (she/her)
Psychiatric Nurse Practitioner
Michele Tulk is a psychiatric nurse practitioner at WWU’S Student Health Center. She enjoys playing video games, eating yummy and delicious things, learning to play new sports (ice hockey and rowing most recently), and cooking/baking. Her passions include anything related to promoting mental wellness, racial justice, and support of the LGBTQ+ community.
Lucia Pearson, ARNP, MPH (she/her)
Adult Nurse Practitioner
Lucia Pearson is an Adult Health Nurse Practitioner at WWU’s Student Health Center. She moved back to the Pacific Northwest from the East Coast in 2014 and enjoys spending time in nature, gardening, practicing yoga and dancing. She is passionate about health equity, mental health, and partnering with students to take care of their wellness needs. She is psyched to be part of the Gender Affirming Care Team.
Katie Cook, RN, BSN (she/her)
Katie Cook is a Registered Nurse and received her Bachelor of Science in Nursing at WWU. She enjoys advocating for students in their health care needs at the Student Health Center and is excited to be a part of the Gender Affirming Care Team. She believes everyone should have compassionate and inclusive health care. Katie enjoys spending time with her family, friends, and animals. She also loves art in all forms, time in nature, and yoga. In the summer you will find her reading a book in the sunshine!
Renee Wilgress, ARNP, FNP (she/her)
Family Nurse Practitioner
Renee Wilgress is a Family Nurse Practitioner at WWU’s Student Health Center. She enjoys nature, solitude, music, gardening, friends, and family. Her passion in health care is access, equity, and autonomy. The empowerment of individuals for self-care, awareness, and health choices enables a mentally and physically healthier community. Being a trusted member of the Gender-Affirming Care Team at WWU is an honor, and I look forward to being a part of your support team.
Sindy De La Garza, LPN (she/her)
Licensed Practical Nurse
Hi my name is Sindy. I have been a nurse for 18 yrs and you can find me at the Student Health Center. I have 3 kids, 2 cats and 2 dogs who keep me busy off campus. I enjoy listening to all types of music, love cooking. I am a foodie 😊! I love exploring new places and would like to do more traveling in the future. What interests me about being part of the Gender-Affirming team is learning more about it and being able to teach what I have learned to others including fellow colleagues. I believe everyone has the right to great healthcare and I am here to help you feel comfortable in voicing needs and concerns. I feel honored in being part of a team that is so passionate about students getting the best services possible to fit their individual needs.
The Counseling and Wellness Center at Western Washington University helps to facilitate student success and psychological well-being through culturally sensitive clinical services, outreach, prevention efforts, and consultation. The Counseling and Wellness Center offers individual, group, and couples counseling along with workshops and outreach to the campus community. The Counseling and Wellness Center is staffed by a team of licensed psychologists, counselors, social workers, health promotion professionals, and support staff.
Connect with a Counselor
To get in touch with a counselor you can call 360-650-3164 during the Counseling & Wellness Center’s drop-in hours Monday through Friday, 10 AM - 4 PM. You can request to meet with a member of the Gender-Affirming Care Team during your consultation.
Sanjana Satishkumar (she/her)
LGBTQ+ Student Support Specialist
Sanjana is the LGBTQ+ Student Support Specialist and a Licensed Mental Health Counselor Associate at the Counseling and Wellness Center. Sanjana uses a foundation of person-centered approach and brings in aspects of other approaches such as Cognitive Behavioral Therapy, Mindfulness, and Solution Focused Therapy.
Sanjana has experience working with individuals from diverse experiences and identities, and is mindful of how intersections of cultures/identities/experiences can influence an individual’s mental health, goals, etc. She has had the opportunity to work with queer and trans folk from various backgrounds and provide support through individual therapy and outreach. She completed her Masters thesis examining discrimination and distress experienced by queer people of color and how social support plays a role for the distress experienced by QPOC.
Deidre Evans, MSW (she/her)
Survivor Advocacy Services Coordinator
Deidre Evans is the Survivor Advocacy Services Coordinator at Western. She enjoys spending time with loved ones, cooking new recipes and sharing food, traveling, being active in nature, caring for plants and learning new art forms. Deidre brings 10+ years’ experience working directly with survivors of intimate partner (dating & domestic) and sexual violence.
Deidre believes that safety and autonomy over one’s body are a fundamental human right that every person deserves. She joins the Gender-Affirming Care Team because she wants to be a resource to student survivors of violence in their gender affirmation journey. Deidre sees every survivor as the expert of their lived experiences and works each day to create a space where students feel supported in the next steps and goals that they set for themselves, their relationships, and their healing.
Sarah Kapostasy, MA, LMHC (she/her)
Sarah has a background in community mental health and previously served for 7 years as the Clinical Director of a LGBTQIA+ nonprofit organization. As a therapist, Sarah strives to provide warm, person-centered, and strengths-based care while using solution-focused strategies. She emphasizes a collaborative approach which honors everyone’s unique life experience and existing wisdom. She especially enjoys working with college students of all ages, given the opportunities for challenge and growth during this life transition.
Sarah is excited to join the Gender-Affirming Care Team to provide support to students wherever they may find themselves in their gender-affirming journeys. She will continue to advocate for an informed consent approach to medical care while seeking to provide mental health and practical support with limited barriers to make the process as painless as possible.
Campus partners serve on the Gender-Affirming Care Team as key advocates for the holistic health and well-being of trans and non-binary students. They work collaboratively with clinical providers to ensure accessibility of services, help to facilitate referrals, and connect students to resources.
Hello everyone. As LGBTQ+ Director, I support students, supervise the LGBTQ+ Western student employees, organize educational programs, and collaborate with others throughout campus to make WWU more LGBTQ+ friendly and inclusive. I focus my work on intersectionality.
I attended Western Oregon University where I found my passion working with college students through involvement in the LGBTQ+ student organizations and centers, including hosting their annual drag show. I got my Master of Science from Colorado State University and returned to Western Oregon University to be a Resident Director. I worked in local government as the Equity, Diversity, and Inclusion Coordinator for Benton County until August 2022 when I joined the Access, Diversity, Equity, and Inclusion team at WWU.
My role on the Gender Affirming Care Team is to help coordinate with and connect students to providers and other members of the care team. I currently co-lead our monthly meetings and help connect our team to other events and services across campus. I encourage you to visit the LGBTQ+ Western webpage, where you can schedule an office hours meeting with me.
Yarrow Pospisil, CCC-SLP (she/her)
I feel honored to be part of the Gender Affirming Care Team. I'm a Clinical Educator in the WWU Speech-Language Clinic with extensive training and experience providing gender-affirming voice and communication services to the gender-diverse community. I'm passionate about my role in supporting each person’s authenticity, self-expression, and sense of well-being. In addition to being a licensed and certified Speech-Language Pathologist, I have been a Certified Trainer for the Center for Nonviolent Communication since 2006.
My work as a trauma-informed therapist, coach, and consultant spans medical, educational, private practice, business, and non-profit settings. In addition to my work at WWU, I have a part-time private practice as an empowerment and empathy coach, with a focus on healing and reconciliation and creative conflict engagement. My values as a service provider are rooted in compassion, humility, empowerment and inclusion of diverse perspectives, and a sense of belonging for all. I consider myself a committed lifelong learner, have two amazing children who teach and inspire me daily, and I love spending time outdoors.
Charlie Flewelling (they/them)
Access Manager in the Disability Access Center
Charlie’s academic and professional backgrounds are in education, disability, gender, and the law.
They enjoy cooking, finding community, and connection over shared food and space.
Their specific interest in access stems from lived experience with multiple impairments.
What to Expect
We recognize that the process of starting gender-affirming hormones can feel all sorts of ways – exciting, scary, joyous, uncertain, and sometimes several of these things together. The Gender-Affirming Care Team acts with honesty, transparency, and respect. To that end, it is our responsibility to help manage expectations throughout the process. Here are some helpful reminders if you are considering gender-affirming hormones:
Hormones will not be prescribed at the first visit
Physical changes take time
Insurance can be hard to navigate (and we’ll do our best to help you)
You do not have to attend appointments alone – bring a friend if that makes you more comfortable!
Some changes are reversible while others are not
Hormones are just one aspect of gender affirmation. Your gender identity is real and valid whether or not you choose to take hormones. And hormones are not a cure-all.
We are here for you if you initiate hormones AND if you don’t!
Read more about what to expect with estrogen.
Read more about what to expect with testosterone.
To get started with gender-affirming hormones, students can call the Student Health Center at 360-650-3400 and ask to schedule a gender-affirming consultation.
Get to know your provider and time for your provider to get to know you! Discuss your health history, experience of gender, goals related to gender-affirmation; learn about available resources and the Gender-Affirming Care Team and discuss potential risks/benefits as part of the informed consent approach.
Now that you’ve had a chance to get to know one another, this appointment will focus more specifically on informed consent and a check of your physical health, including blood pressure, a heart and lungs check, and collecting a baseline blood sample to further evaluate any possible risks upon starting hormones.
Third or Fourth Visit
A continuation of informed consent, collaborative discussion around medication options to affirm your gender, and possible initiation of hormone therapy.
Informed Consent Approach
The clinical staff of the Gender-Affirming Care Team uses an informed consent model. Informed consent is collaborative, educational, and patient-centered. As a patient, you have the right to ask questions, advocate for your needs, seek a second opinion, or refuse treatment.
Informed consent removes barriers and increases access to treatment. A letter from a medical or behavioral health provider is not a requirement to access gender-affirming hormone therapies. A provider may still request a behavioral health assessment as part of meeting criteria for hormones to ensure mental health concerns are reasonably addressed, which aligns with WPATH standards of care.
As part of our multidisciplinary approach to care, the Gender-Affirming Care Team meets regularly. This is an opportunity to discuss relevant policies, procedures, feedback, and best practices. During these meetings, identifying patient information or protected health information is not disclosed in accordance with confidentiality requirements including HIPPA. In smaller meetings between clinical members of the Gender-Affirming Care Team, patient cases may be discussed to ensure coordination of care, referral, and follow-up. Clinical members of the Care Team will discuss this process in detail with their patients. If a patient does not feel comfortable having their case discussed their provider(s) will respect their decision to not share information unless there is a compelling reason to do so (e.g. health and safety).
Informed consent for testosterone therapy
Informed consent for estrogen therapy
If the thought of needles makes you squirm, or you’d like one of our nursing staff to walk you through the process of self-injection, just schedule a visit! You can also watch a video on self-injection or download a self-injection guide.
Safe disposal of needles is important! Your provider can prescribe you a sharps container or you can make one yourself. If you want to DIY, follow these steps:
Choose a sturdy, opaque container (i.e. an empty bleach or laundry detergent bottle or an empty coffee can).
On large label mark: “DO NOT RECYCLE—SHARPS/SYRINGES.”
Secure the lid with duct tape and place container in the regular trash.
Continuing Gender-Affirming Hormone Therapy
To establish care with a medical provider who can continue prescribing gender-affirming hormones simply call the Student Health Center at 360-650-3400 and request an appointment with a member of the Gender-Affirming Care Team for hormone maintenance.
You betcha! LGBTQ+ Western provides one-on-one support and connection to resources, great programs including Trans Tea gatherings twice a month, and a wealth of information on their website. If you’re not sure where to turn, LGBTQ+ Western is a good place to start. The Counseling & Wellness Center offers a variety of support and therapy groups, including Queer Connections. T.A.G. (Team for Transgender and Gender Non-Conforming Students) is a student-led club and the Queer Resource Center is a student-run space for support and information.
To get started with changing your name on campus, there is information on the LGBTQ+ Western website. To change your name or pronouns within the Student Health Center, you can either talk to your provider or make changes through MyWesternHealth. To change your name or pronouns at the Counseling & Wellness Center, just let your provider know.
To obtain a legal name change in Washington State you will need to submit a petition to the court. To learn more about changing your name on your driver's license, passport, etc. The National Center for Transgender Equality has a comprehensive website where you can research requirements based on state/territory. JoeHahn, the LGBTQ+ Director, is a great resource.
Your first step is to contact the Student Health Center and ask to schedule an appointment to discuss gender-affirming hormones!
Generally, there are three routes of administration for gender-affirming hormones: Injection, topical gel/patches, or in pill form. There are pros and cons to each type though injection is the most common. You and your provider will discuss which option is best for you.
We know many individuals starting gender-affirming hormones are eager to see changes and, change takes time. For some individuals starting on estrogen, they may begin to notice breast growth between 3-6 months, redistribution of body fat around the same time frame, and decreased testicular volume around the 3-6 month mark as well. With testosterone, individuals could start to notice fat redistribution between 1-6 months, cessation of menses between 2-6 months, deepening of voice around 3-12 months, and facial/body hair growth between 6-12 months. Changes are highly individualized and based on several factors. Learn more about what to expect from estrogen and testosterone.
How hormones affect you depends on your physical and mental health, whether you smoke, and your genetics. Hormones can affect your mood. People on estradiol might feel more sensitive or moody; those on testosterone might feel more irritable or aggressive. Sometimes estradiol decreases libido; testosterone generally increases it. Testosterone can thin the mucosa of the internal genital space/vagina. Testosterone use during pregnancy can harm or kill a developing fetus. Long-term hormone use can affect fertility, how much so depends on length of use and individual factors. Hormone use can reveal a blood clotting disorder when someone using them gets a DVT or pulmonary embolism. Testosterone causes increased red blood cell production and rises in hemoglobin and hematocrit; blood levels are monitored for this reason. Using testosterone sometimes uncovers bipolar disorder, schizophrenia, or psychosis; for this reason, you should share your and your family's mental health history with your provider. Rarely, someone on testosterone can develop a tumor in their pituitary gland; new nipple discharge might signal this side effect. Someone with risk factors for or family history of gallbladder disease might have gallbladder inflammation or stones on estradiol. Smoking cigarettes is not a good idea if you use hormone therapy; it increases your risk of blood clots and other cardiovascular disease. Currently, there is no strong evidence that estradiol or testosterone therapy causes breast, ovarian or colon cancer.
The short answer is no. Counseling, Health, and Wellness adheres to an informed consent model. This means you do not need a letter from a therapist or medical provider to begin hormones at the Student Health Center. The long answer is that for some individuals, a letter or assessment may be requested from a behavioral health provider (e.g. therapist) to confirm that any underlying mental health conditions are reasonably well managed. This is consistent with WPATH standards of care and eligibility for gender-affirming hormones.
Generally speaking, your insurance should cover your labs. Ask your provider to make sure they use the ICD 10 code for "endocrine disorder." Some insurance companies will not pay for gender affirmation, so we need to use codes they do accept. If you do not have insurance, we recommend applying at the WA Health Plan Finder or for insurance through WWU. If you do not have insurance or if you don't want to use your parents/guardian’s insurance, it's sometimes possible to get a panel of hormone labs from Quest for about $70. If you want to use your parents/guardian’s insurance, but want confidential care, read more about confidentiality on the Student Health Center website.
Generally speaking, the pill & injectable forms of estradiol and the injectable forms of testosterone are least expensive, running $10-40/month if you pay cash and use a GoodRx coupon. You might have better insurance coverage than this and opt to use your insurance. Sometimes it makes sense to use a more expensive form of replacement like patches if you have more cardiovascular risk factors or a history of blood clots. Your provider can help you figure out cost and strategies to access medication during your consult.
If needles make you queasy, not to fear! Our nursing staff on the Gender-Affirming Care Team can coach you until you feel comfortable with self-injection. There are options other than injection for taking hormones, too. Additionally, this self-injection guide from The Fenway Institute and video from Planned Parenthood are great resources!
Obtaining a letter for gender-affirming surgeries may involve documentation from both a therapist and medical provider, depending on several factors including type of surgery, insurance coverage, and clinic/surgeon policies. Clinical members of the Gender-Affirming Care Team have training and experience with providing letters of support, consistent with WPATH standards of care. If you need a letter, the first step is talking to your provider.
Yes and no. Clinical members of the Gender-Affirming Care Team (medical providers and therapists) can share information between the Student Health Center and Counseling & Wellness Center to ensure the highest quality of care and coordination of services. Your provider will let you know if they plan on speaking with another clinical member of the Care Team. Providers cannot share protected health information without your explicit consent to anyone else on the Care Team. When information is shared between providers, only necessary details and the least amount of information will be disclosed.
If you are unable to use the insurance you are covered by or don’t have insurance there are several options. You could explore the possibility of going on Apple Health (Washington State’s Medicaid program) or paying out-of-pocket. If you have questions or concerns about insurance coverage (we know it can be overwhelming and confusing), talk to your provider. They can help connect you to the resources and answers you’re looking for.
New evaluations for voice and communication training through the Speech-Language Clinic on campus are currently on hold. Locally, Catalyst Therapies offers this service along with the following virtual options: Give Voice, Jordan Ross Communications, and Maryam Sadrzadeh through Evergreen Speech and Hearing Clinic.
Sometimes insurance companies restrict access to medication based on cost or expected use. This can result in delays. Insurance companies have "formularies" or lists of medications that they prefer to cover. Sometimes they want you to try a less expensive medication first. Sometimes they want you to use a generic rather than brand name medication. And sometimes they require chart notes and a formal request (the PA form). This may occur if someone's legal gender is still female, but they want to use testosterone. Not to worry! We will help you sort out how to access your medication.