‘Nothing is ever affirming’: Trans KPU student denied coverage for testosterone by KSA health plan

A trans Kwantlen Polytechnic University student who uses prescribed testosterone has faced issues receiving coverage for his medication through the Kwantlen Student Association’s health plan.

GR, who requested to be referred to by his initials, is a third-year graphic design student. He uses Testosterone Enanthate Injection, a generic version of testosterone suspended in sesame oil. It is manufactured by the pharmaceutical company Hikma Canada Limited.

In 2024, GR’s coverage for his hormone replacement medication was denied and he had to cover the costs out of pocket.

While prescription drugs are 90 per cent covered under the MyStudentPlan, providing a maximum drug coverage of $3,000 per benefit year, GR had to pay for 100 per cent of his medication.

“Even if it was just 10 per cent, I would have been happy with that. But it came back completely denied.”

GR says masculinising hormones aren’t covered in regular extended health programs offered through the government and require Special Authority (SA). 

SA provides full or partial coverage for a drug that is not covered in specific medical circumstances. The decision for such coverage is often based on patient medical history and diagnoses, the B.C. Ministry of Health wrote in an email statement to The Runner.   

It added that B.C.’s PharmaCare program prioritizes the coverage of “safe, medically effective and cost-effective therapies.” Canada’s Drug Agency recommends covering certain drugs under the provincial plan based on therapeutic value and cost effectiveness, the statement read. 

“Coverage of pharmaceuticals is not included in the Canada Health Act, so the types of drugs and level of coverage can vary between provinces.”

While the Testosterone Enanthate Injection GR uses is covered under certain indications, including female-to-male (gender) transformation, SA approval is required before a patient pays for their prescription. 

“[SA] is an absolute nightmare to get and sometimes they deny it just because they can,” GR says. “It can take a year or longer to get that approval. So in the meantime, you’re still paying for your medications out of pocket anyway, and they don’t backdate it.”

The KSA offers health and wellness coverage through MyStudentPlan and MyWellnessPlan respectively. The association also offers MyVirtualDoctor, which provides eligible students and their dependents with 24/7 access to virtual health care.

Gallivan, which is rebranding under Alumo, is the student health and dental insurance provider the KSA works with to offer health coverage to KPU students.

In January 2024, then KSA queer students representative Destiny Lang delivered a presentation to the student union’s council at the time about gender-affirming care and how the KSA can be a leader in providing this coverage.

Gender-affirming care can involve a range of services — ranging from hormone, speech, and mental health therapy to surgeries — and is aimed at aligning people’s physical traits with their gender identity and supporting their gender expression.

In B.C., the three pathways to access hormones are through a primary care provider, referral to an endocrinologist — a hormone specialist — or from a trans-specific care provider or clinic.

“It’s important to note that gender dysphoria is not a mental illness and being transgender is not a mental illness either,” Lang said during the 2024 presentation, adding affordable access to gender-affirming services would help remove barriers and support transgender and non-binary individuals’ gender identity and mental health.

Sean Gallivan, then client relations specialist at Gallivan, said at the meeting that including gender-affirming care coverage to KPU students’ current health and dental plan would cost an extra $9 plus tax for all students per year.

The KSA’s health and dental plan website reads that it helps cover prescription drugs and costs the provincial health plan doesn’t cover. 

GR says he couldn’t find a reason behind his medication not being covered or a list of prescriptions that were excluded from the plan. 

While the drug identification number (DIN) GR had filed a claim with was denied, testosterone is listed under a different number, DIN 90800234, on the MyStudentPlan portal as a covered prescription.

He reached out to the KSA and Canada Life in August 2025 to ask why testosterone was listed as being covered on the MyStudentPlan portal if his claim for coverage was denied.

“Nobody could give me a straight answer. I emailed them … and it took a little bit of back and forth, and at first, they just didn’t answer the question at all,” he says. “Their answer was that the government doesn’t cover it through normal means, so we can’t cover it through normal means.”

Canada Life did not respond to The Runner’s request for a comment before publication time. 

KSA Benefits Student Services Coordinator Sally Le told GR in an email response that his medication should fall under the BC PharmaCare formulary and only the drugs PharmaCare covers will be covered under the KSA plan. 

She added that some drugs that have been reviewed by PharmaCare might show up on the database even if they aren’t covered. Such drugs are marked “NB” in the “Maximum PharmaCare Covers” column on the portal. 

Le further wrote the drug GR had requested requires Special Authority by the prescriber. 

While there is a special process to handle exceptions, which include drugs that aren’t covered under insurance, it requires the student to be considered for drug exception only if they have tried at least one medication on the student health plan, Le wrote. 

GR says neither Canada Life nor the KSA addressed why feminising hormones such as estrogen were covered but masculine hormones were not.

“They just completely ignored it, like I hadn’t even asked,” he says. “I’m so glad people who are on feminising hormones get that coverage. But when it comes to our coverage … more coverage for me does not mean less coverage for somebody else…. It just feels discriminatory.”

In an email response, Canada Life told GR that his medication, DIN 02536315, which wasn’t listed on the KSA portal, may be eligible for benefits under the provincial specialty drug program. GR was told to work with his doctor to apply for this program and send a provincial response letter to Canada Life. 

GR says he was under the impression that hormone replacement for testosterone would be covered under the umbrella of gender-affirming care when the KSA decided to cover it under the health and dental plan in 2024.

“The base diagnosis is gender dysphoria. It should not matter in what direction you’re trying to change yourself,” he says. “It should be equal across the board. But it’s not, unfortunately.”

He adds that while the plan covers some gender-affirming surgeries, hormones that accompany these procedures aren’t covered. 

“[It] is just very strange to pick and choose which ones you do and do not want to include.”

After his coverage was first denied in fall 2024, GR decided to pay more than $300 for his medication out of pocket, plus an additional $200 for supplies. 

“We apologize for the misinformation that led to you registering in our claims platform, and any confusion this has caused,” KSA Benefits Student Services Assistant Prince Nishalika wrote in a followup email to GR in late August.  

“I didn’t really have the mental energy to try and deal with it because I was dealing with school and everything else at the same time,” GR says.

GR adds he didn’t have a choice about paying for his medication and was going to pay for it even if it wasn’t covered by the KSA or Canada Life. Since then, he has had his medication filled several times at his own expense. 

Having no external income and relying on student loans after having quit his job to focus on a rigorous course load in his third year, GR hopes his testosterone medication will at least be partially covered. 

“So 100 per cent of my medication and supplies to give myself the medication are coming out of my pocket. Alleviating a little bit of the monetary burden of just trying to live my life as who I actually am, would be a little bit helpful at the very least,” GR says.

He says the supplies include syringes and alcohol prep pads to administer the medication, which comes in the form of an injectable liquid. 

With it being in liquid form, GR says he also doesn’t get to use the medication to its full potential. 

“I can never get the exact amount out of the bottle. It’s not like a pill where I’m using it every 30 days. It’s an injectable liquid, so there’s always a little bit of dead space that happens in the needle,” he says. “There’s a little bit of loss in the bottle itself that you can’t pull out of because there’s not enough left.”

In an email statement to The Runner, the Gallivan team wrote that the organization serves as an insurance consultant to the KSA and represents the association in negotiations with Canada Life.

“The KSA owns the plan and determines the coverage it wishes to provide to its members, with Gallivan providing advice, analysis and market insight,” they wrote, adding that the KSA is the final decision-maker in determining the coverage it wishes to provide to its members, with Gallivan providing advice, analysis, and market insight.

The student health group also wrote that the KSA health and dental plan is built on the PharmaCare drug formulary, with coverage determined by how specific drugs and DINs are listed under the provincial framework, not by whether a treatment is feminising or masculinising.

“We recognize that this can result in unequal access to care from a student’s perspective. Gallivan works with the KSA to help identify these situations, support exception requests where appropriate, and reduce barriers to accessing gender-affirming care.”

Gallivan wrote that coverage depends on the specific DIN associated with a prescription, which can lead to “different outcomes for medications that may appear clinically similar.”

“Some testosterone products are listed as regular benefits under the provincial formulary, while others may require approval through the Special Authority process,” the statement read.

“We recognize that DIN-based distinctions are not always intuitive. When a claim is denied, students can receive support through the KSA Benefit Plan Office to confirm eligibility, explore exception options, and identify alternative pathways to coverage when available.”

GR says the process in finding and accessing information about coverage on the KSA website has been convoluted and he feels like he is “being forced to chase somebody for an answer.”

“It does get very disheartening to try and navigate the medical system as a trans person,” GR says.

“It feels like you have to swim upstream, like everything that is in place is trying to work against you and nothing’s ever easy, nothing is ever affirming. You always have to explain yourself away. You have to justify your reasons for doing anything.”

GR hopes to see all hormones — whether feminising, masculising, or anything associated with gender transitions — are covered by the KSA’s plan.

“At the end of the day, if there isn’t equality or equity for everybody involved, we’re never going to be on the same ground or level to be able to care for each other and to advocate for ourselves.”