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Transgender TelemedicineWith the COVID-19 pandemic evolving rapidly across the world, most medical resources were focused on those people infected with the virus. Transgender telehealth has been of particular benefit to the transgender community during this time, given their risk of poorer health outcomes compared to their cisgender counterparts. Even though over a million Americans identify as transgender, there continue to be barriers and all-out refusals to adequate transgender health insurance and services. With the COVID-19 outbreak, transgender persons now face additional social and psychological difficulties as well as generalized healthcare access inequities.

In a 2018 article entitled, Should Gender Reassignment Surgery be Publicly Funded?, author Go comments, “Transgender people have among the highest rates of suicide attempts of any group in society, driven strongly by the perception that they do not belong in the sex of their physical body. Gender reassignment surgery (GRS) is a procedure that can change the transgender person’s physical body to accord with their gender identity. The procedure raises important ethical and distributive justice concerns, given the controversy of whether it is a cosmetic or medical procedure and the economic costs associated with performing the procedure. This paper argues that there is a strong case for funding GRS as a matter of clinical necessity and justice.”

Hamnvik and colleagues discuss the serious healthcare inequities experienced by members of this community in the abstract to their article, called “Telemedicine and Inequities in Health Care Access: The Example of Transgender Health“. It states, “One vulnerable group that can benefit from telemedicine is transgender and gender nonbinary (TGNB) individuals, who have less access to both gender-affirming and general medical care due to the consequences of stigma, discrimination, and marginalization. Telemedicine allows TGNB individuals to access clinical expertise even if it is not available locally, and without the expense of travel and without the concern for exposure to discrimination and mistreatment. However, lack of access to or expertise in navigating the required technology, lack of a safe and confidential space to access care, and an unpredictable regulatory and reimbursement environment remain hurdles for harvesting the full benefits of telemedicine.”

Benefits of Transgender Telemedicine

Over the last few years, the number of companies offering transgender-inclusive health services and insurance has steadily risen; an impressive growth considering 20 years ago, no companies offered these options. The barriers for transgender people getting access to adequate health services can be largely attributed to the cosmetic vs. medically necessary gender reassignment surgery (GRS) debate. Health insurance providers use guidelines to approve or deny services and treatment based on whether GSR is deemed a cosmetic or aesthetic procedure or medically necessary for the individual’s health. Many of these providers categorized GRS and associated treatments or services as cosmetic and not medically necessary. This is considered discrimination in the transgender community. Many argue that GRS is clinically and medically necessary to align a person’s physical body with their gender identity. There is a strong push for medical authorities from the transgender community to accept that GRS is an effective treatment for those who meet the criteria. (Johann. J, 2018).

Telemedicine now plays a vital role in GRS and associated treatment or services. Following the GSR, there is a need for monitoring and assessment of wound healing. Scheduled telemedicine consultations assist with the early identification of complications. In a 2020 study entitled, Telemedicine in Transgender Care: A Twenty-First–Century Beckoning, Assad and colleagues stated, “The advent of telemedicine has undoubtedly revolutionized the practice of health care. With advances in photography and live relay quality, and the ease of data transmission through the Internet, telemedicine has great potential in plastic surgery. The majority of consultations in plastic surgery require visual diagnoses, thereby enabling telemedicine to help tackle issues of health care costs and accessibility.”

Challenges of Transgender Telemedicine

While the benefits of transgender telemedicine are easily understood by the experienced telehealth community, there challenges. They include:

  • Legal implications of providing care if the patient is located in a state where the clinician is not licensed
  • Inadequate reimbursement of telemedicine services
  • Difficulty with establishing rapport remotely
  • Inability to perform a physical examination
  • Lack of clinician experience with telemedicine (including practical concerns, documentation requirements)
  • Lack of high-speed internet connection
  • Lack of private space for the patient to attend telemedicine visits

Example: Transgender Telemedicine APPS

Plume, the first of its kind, a dedicated transgender-focused health technology company, was built to ease transgender patients’ healthcare barriers. Plume made a partnership with Solace, a free transgender mobile application available on Android and iOS, to provide transgender people virtual hormone therapy access. A gender-affirming hormone therapy, also known as hormone replacement therapy (HRT), is a treatment process in which a person takes hormones to align their physical characteristics with their gender identity. The Solace provides information to people who seek gender-affirming hormone therapy and pair them with licensed medical professionals through a HIPAA-compliant app. Many of the care providers are transgender people themselves. Plume hopes that creating more accessible telemedicine care methods will help with mental health challenges that transgender people face.

Following Plume’s steps, a new telehealth platform called Folx is designed to provide healthcare services to the queer and trans community. Like Plume, Folx provides hormone replacement therapy (HRT) to those in the midst of their transitional journey in the comfort of their homes. Rather than just hiring any physician, Folx providers are required to have years of experience treating the transgender community, and a vast majority of their professionals also identify within the queer community. Some people, however, still have doubts about replacing their in-person doctor’s visits with virtual consultations. Now with telemedicine as a mainstream option, the road to equal healthcare for the trans, intersex, or non-binary seems much brighter.

Conclusion

Telemedicine and transgender care have been evolving for the past few decades mostly because of social awareness and recognition. After surgery, individuals who have undergone GSR are able to discreetly benefit from periodic healthcare evaluation and psychosocial support through telemedicine intervention. Rather than blanket bans on surgery and other treatments, case-by-case decisions can improve transgender people’s access to appropriate telemedicine services and improve health outcomes within the community (especially depression and suicide rates). Further studies are needed to explore telemedicine’s effectiveness and improvements to gain result-oriented outcomes for the underserved population. 

References

  • Go J. J. (2018). Should Gender Reassignment Surgery be Publicly Funded?. Journal of bioethical inquiry15(4), 527–534. https://doi.org/10.1007/s11673-018-9881-6
  • Hamnvik, O. P. R., Agarwal, S., AhnAllen, C. G., Goldman, A. L., & Reisner, S. L. (2020). Telemedicine and Inequities in Health Care Access: The Example of Transgender Health. Transgender Health.
  • Asaad, M., Rajesh, A., Vyas, K., & Morrison, S. D. (2020). Telemedicine in Transgender Care: A Twenty-First-Century Beckoning. Plastic and reconstructive surgery146(1), 108e–109e. https://doi.org/10.1097/PRS.0000000000006935

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