As the school year ramps up, here’s what’s happening with transgender students and their health in education.

In the past year alone, Texas attempted to pass 30 anti-LGBTQ laws — and while this makes it the most LGBTQ-unfriendly state in the U.S., the state legislature was hardly acting alone: 16 other states considered so-called “Bathroom Bill” legislation that would require people to use the gendered bathroom that conforms with their birth sex, bringing transgender students and bathrooms to the forefront of trans rights conversations. It’s no wonder, then, that while other students are busy picking out pencils and backpacks, transgender students have far bigger issues to worry about.

As the school year ramps up, we’re taking a look at how this legal controversy is affecting transgender students. Here are four ways in which trans students are not receiving adequate healthcare in schools.

1. Non-Inclusive Anti-Bullying Policies

Is making fun of a trans elementary student for using the bathroom of their preference bullying? While we say “of course!”, most school districts do not clearly identify these types of aggressions as “bullying.”

Calling a trans student by the wrong pronouns is just as harmful as calling a student “stupid” — in fact, considering that trans people are more likely to deal with depression and anxiety in than in their cis counterparts, transphobic behaviors are arguably more detrimental to a trans student’s mental health. And yet most school policies — especially in elementary and middle school — do not clearly identify mis-gendering as bullying. Without identifying this behavior as wrong, students may grow up to be the same doctors that subject trans patients to microaggressions later in life.

2. Lack of Gender Neutral Bathrooms

Nearly two thirds of transgender students, and Americans in general, have avoided using public restrooms for fear of confrontation, saying they have been harassed and assaulted in the past. In schools, this is particularly troubling, as bathrooms are typically communal. As one mother of a trans child recently pointed out, “The nurse’s bathroom is out of the question for my son, because separating him from his peers for being different is the exact same thing that bullies do, and besides: Even the Supreme Court has said that separate isn’t equal.”

Providing gender-neutral bathrooms for all students, not just ones that identify as trans, is hugely important in educational environments.

3. Lack of Trans Inclusive Healthcare In Colleges

Even after transgender students endure the bullying and bathroom-related issues that arise in elementary, middle, and high school, there are additional hurdles they must jump in college. Currently, 86 colleges and universities offer student health insurance that covers hormones and gender-affirming surgeries for students. While it’s encouraging that so many do, this is still a relatively small portion (six percent) of the approximately 1,400 colleges and universities in the country, which is just one of many ways our healthcare system fails trans patients.

4. No Clear Nationwide Guidelines for Transgender Students in Athletics

Because there are no nationwide guidelines for trans students in sports, each state has developed its own — which makes for confusing and uncomfortable scenarios. For instance, because of the Texas law that requires students to play on the team that conforms with the sex on their birth-certificate, Mack Beggs, a transgender boy who was taking medically prescribed testosterone, won the state girls’ wrestling championship — amidst both boos and applause. As Beggs put it, “change the laws and then watch me wrestle the boys.”

Read More: A GNC Therapist Debunks 5 Myths About Gender

What This Means for Transgender Students’ Mental Health

These persistent inequities have taken their toll on trans students. New research from the Journal of the American Academy of Child & Adolescent Psychiatry shows that a trans student’s environment — whether positive or negative — can have a serious impact on their mental health and the chances that they will develop suicidal thoughts. Nearly 35 percent of transgender students in the study reported having suicidal thoughts, compared to approximately 19 percent of non-transgender students.

What’s more, a national survey of over 14,000 college students across the U.S. found that, when asked to rank the extent to which they agreed with the statement “I am optimistic about my future,” only 14.8 percent of trans students responded “strongly agree,” in contrast to 29.8 percent of cisgendered students.

The Path Forward: Creating Legislation That Reflects Our Population

Despite the pervasive transphobia present in many American schools, it is encouraging that universities are, in general, beginning to adopt more inclusive policies. But real, widespread change must take place on both a policy and administrative level. That means electing and hiring more trans and trans-affirming legislators and campus leaders, asking about and listening to the experiences of trans students, and educating every student and parent — regardless of gender identity — about the microaggressions and outright bias that harm their trans classmates.

While the gap in competent and affordable trans healthcare will persist in the interim, communities like Lighthouse work to connect trans patients with trans-friendly, knowledgeable providers that have experience treating LGBTQ individuals of all backgrounds. In an educational climate that often perpetuates ignorance, it’s more important than ever that our community finds the right care and feels taken care of.

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