In the last several years, a number of new procedures have been made available under our GradCare coverage, thanks to the advocacy of GEO’s Trans Health Caucus. Covered procedures covered by GradCare now include:

  • hormone replacement therapy (available under informed consent)
  • speech language therapy
  • mastectomy
  • major and minor genital reconstruction surgery
  • facial feminization surgery 
  • permanent hair removal
  • tracheal shave
  • fertility preservation

For information on accessing this care, see here. Patients seeking surgical services are required to submit a service inquiry on this page, and either one or two letters of support (depending on the procedure), per the WPATH model of transgender care. GEO maintains the position that this requirement creates unreasonable barriers to accessing medically necessary healthcare benefits. To get involved in fighting against these restrictions, email

Hormones under Informed Consent

For employees on a UM health plan (such as GradCare), Hormone Replacement Therapy (HRT) can now be initiated on the basis of informed consent. This means that employees do not need to submit a psychological letter of support to be eligible for an HRT prescription.

Requests to initiate HRT can be made by scheduling an appointment with one of the Michigan Medicine providers listed here. Providers within the OB-GYN department at Michigan Medicine listed on the above page will see patients without requiring letters. All providers reserve the right to decide, on a case-by-case basis, whether to recommend working with a mental health clinician, though a letter will not be required to meet with the prescriber/physician who prescribes hormones. So long as the provider is willing, they are fully empowered to write a hormone prescription for the patient without a letter. The patient may then proceed to get their HRT prescription filled as they would with any other prescription. 

Under our GradCare insurance, visits with the prescriber/physician to discuss hormones are covered (though there may be applicable copays), and importantly, our prescription drug plan does not require a letter of support as part of the prior authorization process for hormone therapy. In fact, for estrogen therapy, no prior authorization is required at all. For testosterone therapy, the prescriber/physician will need to attest that the prescription is for gender dysphoria (and during renewal, that levels are within the normal range) due to the potential for off-label substance abuse.

Important note: The above discussion applies only to hormone therapy, not to surgery. At this time, either one or two letters of support (depending on the procedure) are required to obtain transition-related surgery, as specified in Revision 7 of the WPATH Standards of Care (2011). GEO maintains the position that this requirement creates unreasonable barriers to accessing medically necessary healthcare benefits. We believe that the barriers arising from this requirement are incompatible with the goals outlined in the University’s Diversity, Equity, & Inclusion plan. 

For more information and context, see our dedicated page here.

Speech Language Therapy

Beginning July 1, 2020, Gradcare covers up to 15 sessions of speech language therapy annually for the treatment of gender dysphoria, e.g., roughly one session every three weeks. Each session has a $25 copay. GEO will continue to advocate for an expansion of the number of covered sessions.

Ongoing Organizing

The procedures above were included under our coverage only through the years-long advocacy and organizing efforts of GEO’s Trans Health Committee. Some necessary procedures are still not covered, and there are important improvements still to be made to trans health care at UM, such as the requirement of (multiple) letters of support to access surgical treatment described above. If you’d like to be involved in these ongoing efforts, or would like to bring a problem area to our attention, please email