It’s difficult to be a student at Yale. It’s even more difficult to be an anxious trans, low-income student of color at Yale — especially when there is no blueprint to follow.

I started transitioning my sophomore year at Yale, relieved that I could finally accept my new identity but anxious because I had no idea what to do next. The little information that Yale had available on transition-related healthcare was abysmal, and I didn’t know anyone who had transitioned at Yale, medically or otherwise. So I had to devise my own plan based on the limited information on Yale Health’s website, online advice from other trans people and guesswork.

My plan needed to account for a few key elements. I needed to complete all medical procedures before graduating in order to be covered by the more than $3,000-dollar Yale insurance. I had to keep working 19-hour weeks because I was a low-income student and paid for my own expenses out of pocket. I had to graduate on time because I had nowhere to go if I took time off.

So I made a plan: find a therapist to give me permission for hormone replacement therapy (HRT). Start using a new name and new pronouns and transition socially. Get further permission for surgery. Work on legal name change and gender marker change. Get surgery. Live happily ever after.

It was a straightforward plan, so I felt optimistic, yet overwhelmed. But I didn’t anticipate how much time I would spend waiting because Yale Health, and the institution of Yale itself, did not have the information or services I needed readily available.

Things started off smoothly. While I did need someone I could discuss my gender dysphoria with, I mostly needed someone who would be able to sign my first medical letter certifying that I needed HRT. Even so, my therapist knew very little about trans healthcare, and even less about resources at Yale. They told me that Yale generally ascribed to World Professional Association for Transgender Health (WPATH) standards and that I would have to see a therapist for a minimum of one year for gender dysphoria before I could request a letter to begin HRT.

It wasn’t until my junior year, after starting HRT, that I spoke to the head of Yale Mental Health and learned that the letter could have been given as soon as the therapist and patient agreed it was needed. I had been ready for HRT about four months into therapy, and it was incredibly frustrating to know that I could have been spared the extra eight months of ever-growing dysphoria had I known that information from the beginning.

I started seeing a new therapist at Yale Mental Health so I could get a second letter to qualify for gender-affirming surgery. But once again, I wasn’t informed until late in my junior year that I didn’t need to see another therapist for that. Apparently, all I had to do was meet with the head of Yale Mental Health for a brief 15-minute interview, and they would decide if I qualified or not. It ended up taking three more months before I was able to schedule an appointment with them, and then another few weeks before I actually received the letter. And so, it took another school year just to take one step forward.

Because of my previous experiences, I wanted to be as proactive as possible senior year (not to mention, the clock on my Yale insurance was ticking). In early August, I contacted Yale Health and set up a meeting to talk about gender-affirming surgery. I met with someone right before classes began, expressed my interest in having surgery and that I was hoping to schedule it as soon as October so that I could enjoy my senior year post-operation. They informed me that it would not be possible because Yale Health had to coordinate with the surgeon they typically outsource to and that October was too soon. I figured they would get back to me in a month; maybe I could have surgery in time for the holidays. When I eventually got my surgery date, it wasn’t until late March.

During the long wait for surgery, I focused on my name and gender marker change. This was now the legal side of transitioning, so Yale was of less help than ever. I was completely on my own. While I successfully changed my name and gender marker on all of my legal documents, I encountered some travel scares, tax issues and utility company complications because I was handling things on my own. The only bright side of all of this was that I had peer and Yale faculty support throughout my transition, which made the social aspect less taxing.

I was dealing with this process as a full-time student with work study, thesis writing, post-graduation anxiety and personal stress. But despite everything you just read, my transition was relatively smooth; not because of Yale, but in spite of it.

If things are to improve, Yale Health needs sensitivity training on trans healthcare and should provide a comprehensive and clear guide on the services they offer. If the Yale Financial Aid Office provided waivers for the insurance to low-income students seeking trans healthcare, it would be more accessible.

Despite its limitations, trans healthcare at Yale is still more comprehensive than what most insurance plans offer. Yale students, faculty and staff should recognize just how hard it is to simply be a trans student at Yale and work on providing the social support we need where other support lacks. Anything less fails trans students at Yale.

Nicolas Aramayo graduated from Yale College in 2017. They work as a paralegal at the American Civil Liberties Union. Contact them at nichoduardo@gmail.com .