Adam Tamburin

USA TODAY NETWORK – Tennessee

Starting this year Vanderbilt University’s student insurance plan will cover transgender-related surgeries, a move school officials say will make the campus a more inclusive environment for students who previously had gone without necessary care.

The change was part of a routine annual review of the university’s health care plan for students. Cynthia Cyrus, vice provost for learning and residential affairs at Vanderbilt, said the committee tasked with the review quickly recommended expanding coverage.

“It was relatively non-controversial on our side,” Cyrus said. “It was maybe a two-paragraph conversation, not deeply debated in any way.”

Cyrus said the decision to cover reconstructive surgeries for transgender students was in keeping with other university efforts. Vanderbilt's plan has covered hormone therapy for transgender students for several years.

Vanderbilt is far from a trendsetter when it comes to expanding students' access to transgender-related surgeries. Seventy-one universities across the country offer the coverage, according to a list kept by the nonprofit advocacy group Campus Pride.

But Vanderbilt stands out because of the politics rippling around its campus.

While many top-tier colleges, like Harvard University and Yale University, have expanded coverage for surgeries in recent years, access in conservative Southern states like Tennessee is far from the norm. Transgender students at the University of Tennessee, Knoxville, for instance, cannot use school-brokered insurance plans to cover hormone therapy or surgery.

When universities decide to expand coverage to cover gender reassignment surgeries, it's usually because students come forward asking for the option, according to Genny Beemyn, the coordinator of Campus Pride's Trans Policy Clearinghouse and the director of the Stonewall Center at the University of Massachusetts, Amherst.

That's what happened at Vanderbilt, said Dr. Louise Hanson, the director of the university's student health center. Hanson brought the proposed change to the committee based on feedback she and other doctors had logged in recent years.

“It came out of feeling limited in our ability to take full and complete care of our transgender students," Hanson said. “It really came out of our frustration."

In an interview with The Tennessean, Hanson recalled talking to multiple students who wanted to pursue gender reassignment surgeries. Some students could afford to pay thousands of dollars for surgery on their own while others couldn't.

“A line was drawn in the sand," Hanson said. "The haves and the have-nots."

Rj Robles, a graduate student at Vanderbilt Divinity School who identifies as transgender, was one of Hanson's patients who could not afford surgery without coverage. Robles — who does not identify as a man or a woman and uses the pronouns they, them and their — is considering breast augmentation, known as top surgery.

But when Robles first went to see Hanson in 2014, the doctor said the surgery was not covered.

It was a culture shock for Robles, who came to Vanderbilt from the University of Illinois at Chicago, where transgender-related surgeries were included in the student insurance plan.

"With that news that my doctor delivered (in 2014), I was going to basically have to put my transition on hold," Robles said. "And that’s exactly what I’ve been doing ever since I started two years ago."

Coverage changes are a normal part of the university's annual review of its student and employee health plans. The university also added coverage for hearing examinations and hearing aids this year.

Hanson said expanding coverage for transgender-related surgeries had been on her team's wish list for a while. Moving forward in 2016 made sense, she said, because there weren't any pending expensive coverage changes and because administrators had made fostering diversity a top priority on campus.

During the 2015-16 school year, conversations about transgender people and gender identity became more common at Vanderbilt and at colleges across the country. Variations of "they" were added to the student handbook as single-person pronouns alongside forms of "he" and "she." A statement in the handbook said the addition was made in an effort to create "a community that is welcoming and inclusive to individuals of all gender identities and expressions."

UT's pronoun post part of a larger college trend

“The timing was right," Hanson said. “That’s where it became more of a topic that we finally felt we could push forward.”

Adding the benefits is not much of a cost to the overall insurance policy because of the small number of people who actually seek treatment, said Dr. Jesse Ehrenfeld, director of the Program for LGBTI Health at Vanderbilt University Medical Center.

In fact, not all transgender patients decide to pursue surgery.

"The challenge, and I think this is an important point, is figuring out what's medically necessary for individual people," Ehrenfeld said.

Hanson estimated that the student health center treats five to eight transgender students a year, although not all of them are pursuing surgery. The student insurance would probably cover one or two operations per year, she said.

But despite the small number of students who will be personally affected by the change, Robles, the graduate student, said the expansion of coverage was evidence of a larger cultural shift for a historically marginalized population.

"I’m really proud of the Vanderbilt community for stepping up, for being on the side of its transgender students," Robles said. "It finally feels like we’re being celebrated, valued, respected, heard and seen. "

Staff writer Holly Fletcher contributed to this report. Reach Adam Tamburin at 615-726-5986 and on Twitter @tamburintweets.