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AUSTIN, Tex. -- Many people don't notice if a restroom is labeled gender neutral. To a transgender student, though, that sign could make the difference about whether they deliberately dehydrate to avoid using the bathroom. A campus doctor asking transgender students their preferred pronoun could reassure them enough to return if they suffer a medical emergency.

Academe nationwide has started identifying small ways to create campuses more welcoming for transgender students as they emerge as a more visible presence and voice their expectations.

But colleges and universities do not all keep to the same pace, depending on support from administrators and the size and will of staff to move on some of these issues. At the annual meeting of campus health professionals here, discussion Friday centered on how to bring simple changes to campuses -- regardless of area political leanings -- that would ensure more inclusivity for transgender students.

These are students who historically grapple with more mental health problems, have a higher rate of contracting a sexually transmitted disease and are sometimes fearful to take advantage of even basic campus services, like a health center.

“Every detail, from pronouns to access to care and access to bathrooms, everything implies the difference between an affirming space where our lives are celebrated and a nonaffirming space,” said Sebastián Colón-Otero, a therapist at the University of Texas at Austin who identifies as a transgender man. “Anything we can do, from changing a brochure to including pronouns in an email, is an incredible step forward.”

Though most studies tend to focus either on transgender adults or transgender youth outside the college-age demographic, the American College Health Association -- which sponsored Friday’s session on transgender students -- administers a countrywide survey of student health, which in 2013 revealed that the transgender population reported more mental health-related issues, as well as harassment, both verbal and physical, compared to their cisgender peers (people whose gender identity matches their sex assigned at birth).

But 50 percent of those transgender students surveyed also indicated they visited their campus mental health centers or something similar, which could be an outlet for university officials to connect those students to other campus resources, said Jenna Messman, the sexual health programs coordinator at the University of Maryland, College Park. Messman led the talk on Friday.

In a later interview, Messman pointed out that awareness of the transgender community has heightened since about 2014 -- commonly referred to as the “transgender tipping point,” named for the Time magazine cover featuring actress Laverne Cox.

Cox and Olympian and reality star Caitlyn Jenner have commonly been credited with taking transgender issues into the mainstream.

The University of Maryland has introduced a slew of efforts aimed at improving the transgender experience on campus, Messman said during her presentation. Some are significant -- such as ensuring that the student insurance plan can pay for hormone therapy for transgender students. Others simply come by removing references to gender. A campaign about menstrual cups referenced “UMD students” who menstruate, rather than women.

Near men and women’s campus bathrooms there are signs advertising where someone can use a gender-neutral restroom, Messman said.

Her university has stressed measuring how well it has accommodated transgender students, Messman said. She showed off the institution’s rating on the Campus Pride Index, an organization that judges how well universities have met the needs of the lesbian, gay, bisexual, transgender and queer campus population. It’s used often when students and sometimes their families are researching prospective colleges. Maryland earned a 4.5 out of 5 for its LGBTQ accommodations.

Atypically, Maryland also participated in the Human Rights Campaign’s Health Care Quality Index, which generally only measures larger health care systems, like hospitals. The university has been designated by the LGBTQ advocacy group as a “leader in LGBT health-care equality.”

The ACHA has released guidelines for assisting transgender students, namely that they should be offered health insurance for hormones and surgical procedures, and medical records should match their gender identity. The association also urges continual training and drafting transgender-specific medical policies.

Early in her presentation, Messman informally surveyed the audience, asking them how well they felt their institutions addressed transgender students' issues. The results were mixed.

At James Madison University, for instance, the training for their campus peer educators until recently was archaic, as a health-care coordinator from the institution described it. It contained “relics” that often singled out gender, describing hypothetical abusers as “him” only, the coordinator said.

Now, peer educators there start by using their preferred pronouns, normalizing the practice.

At the University of Tennessee at Knoxville, a Candy Land-style game called It’s Not Taboo was developed, said Rebecca Juarez, a wellness coordinator at the university.

The game asks questions about sex, but not just about heterosexual intercourse, Juarez said. It also helps remove some of the awkwardness in talking about some of these issues. The concept garnered great interest among some of the other attendees.

“It’s been really effective in bringing sex down to their level, making it approachable,” Juarez told a small group of officials.

Such small touches can help relax not only transgender students, but also those who might not fit the traditional gender molds, said Colón-Otero, of the University of Texas at Austin. Some women might not fit a feminine stereotype, and some men might not be masculine, he said.

Initiating some of these changes hinges on buy-in from the top -- like the university president who is willing to wear a preferred pronoun on a name tag, Messman said.

Campus politics -- such as religious affiliation -- and size can be barriers, she said. But that’s why in her presentation she suggested tinier changes that can accomplished much more easily. Even if there are only three people staffing a health center, when it comes time to refresh certain forms, they could ensure that the references are gender neutral, Messman said.

Students often rely on their time in college to discover themselves and often come out during that period, she said.

“For some students, they’re coming into contact with vocabulary, terminology and people they never knew,” Messman said. “And they’re saying, ‘This is who I am,’ and being exposed to that. That’s why this is so important.”

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