Over the last decade, as activists started pushing colleges to accommodate transgender students, they first raised only basic issues, like recognizing a name change or deciding who could use which bathrooms. But the front lines have shifted fast, particularly at the nation’s elite colleges, and a growing number are now offering students health insurance plans with coverage for gender reassignment surgery.

No college or university offered such treatment just six years ago, but when Brown University said last week that its student health plan would be extended to cover sex-change surgery beginning in August, advocates for transgender students said Brown would become the 36th college to do so. Twenty-five additional colleges do not cover surgery, but their student plans do cover related hormone therapy, and 20 universities have plans that cover some or all sex-change treatments for their employees, according to the Transgender Law and Policy Institute.

Those lists include many of the top American universities — Harvard, Stanford, Cornell, Penn, Emory, Northwestern, the University of California system, Yale, Princeton, M.I.T., Washington University and others. Colleges are not required to provide health coverage for their students, many of whom are still covered by their parents’ plans, but they generally do.

The idea still seems radical to plenty of people; last year, when Sandra Fluke, a law student, became famous for speaking in favor of an insurance mandate for contraceptive coverage, conservatives painted her as part of a fringe element because she also supported sex-change coverage.