Transgender telehealth, Gender-affirming, TDG

Gender-Affirming Transgender Telehealth: TDG Youth Utilization Study

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Safe access to healthcare has been a safety oasis to many transgender and gender-diverse (TDG) people seeking gender-affirming care during the COVID pandemic. Authors of a recent study published in Telemedicine and e-Health evaluated telehealth services supported healthcare access for transgender and gender-diverse (TDG) youth within Seattle Children’s Gender Clinic (SCGC) during the COVID-19 pandemic. Lead researcher Ruby Lucas and colleagues sought to explore the differences in demographic characteristics and completion rates for scheduled visits among transgender telemedicine users and nonusers. The setting was a multidisciplinary gender clinic before and after telemedicine implementation in March 2020.

Transgender Telehealth Study

The electronic health records of Seattle Children’s Gender Clinic (SCGC) patients were reviewed for differences in demographics and type of care utilized by TDG youth. Dates of services received ranged from April 2019 and February 2020 (pre-telemedicine) and April 2020 and February 2021 (post-telemedicine).

Researchers found that 1,051 TGD individuals were seen at SCGC at the stated periods. In the pre-telehealth group, the most frequently reported age for patients was 16 to 17, with 322 of 709 patients in this group. Responses for the post-telehealth group were similar, with 380 of 788 patients reporting age 16 to 17 years.

Other demographic information of note is as follows: 

  • 62% identified as transmasculine/male
  • 68% were non-Hispanic White
  • 76% resided within 50 miles of the clinic. 

TDG Patient Pronouns & Insurance

Researchers found significant differences between the pre-COVID and post-telemedicine groups concerning pronouns and insurance. More patients in the post-telehealth period used “they” pronouns. Using the singular “they,” along with inflected or derivative forms, including their, theirs, and themselves, is a gender-neutral third-person pronoun that is widely accepted for making language more inclusive. It also avoids assumptions about gender. It has become widely accepted by students and faculty in many academic circles.1 

The researchers also found that in the post-telehealth period, more patients paid for their services themselves or used charity care insurance as opposed to obtaining coverage from a commercial payer (third-party payer), Medicaid, or other government options. 

Transgender Telehealth Study Results

In the post-telehealth period, 52 percent of visits occurred virtually and had significantly higher completion rates than in-person visits (72 % versus 50 %). Transgender telehealth visits also had lower cancellation rates (21%) when compared to in-person engagements (46%). In the pre-COVID group, a significantly greater number of cancelations were initiated by patients (68%) than those initiated by patients in the post-telehealth period (58%).

The study found that the transgender youth surveyed were often willing to use telehealth, wearables, and digital health tracking. More than 61% said they were more satisfied with live videoconferencing telehealth than in-person meetings.

Charles R. Doarn is a research professor in the Department of Environmental and Public Health Sciences, director of the Space Research Institute for Discovery and Exploration at the University of Cincinnati, Ohio, and editor-in-chief of the journal. He stated the following in a press release:

Access to healthcare is of vital importance to all of us. TGD care is a growing field that must be addressed, and telemedicine is [a] tool that can make a difference in the care these individuals receive.

Other Telehealth & Technology Topics of Potential Interest

The study outlined above is supported by many earlier studies of the challenges faced by transgender youth and adults. A succinct summary can be found in Telehealth.org’s 2021 article, Transgender Telemedicine and Telehealth Services: A Tremendous Asset. In a companion article titled, Transgender Telemedicine: Inequities and Barriers in Health Care Access, telehealth.org outlined the results of other studies and identifies three specific transgender telemedicine apps which have received notable attention from the transgender community.

In discussing the end of the pandemic, an issue identified as problematic is the remaining restrictions related to practicing across state lines, which can interfere with gender-affirming, transgender care needed by this potentially dangerously marginalized population.

In another study of TGD young adults outlined by Telehealth.org in 2022, the demographics of participants were reported along with the number of self-identified males and females included in a study of Instagram users. It is mentioned here to acknowledge the active collection of gender-affirming data of relevance to transgendered people in general research contexts.

Conclusions

Telemedicine services facilitated continued access to gender-affirming care services for TGD youth during the COVID-19 pandemic. This study supports previous areas of research in transgender telemedicine and telehealth services.

1 The MLA, APA style guides and Merriam-Webster dictionary have added information about the new pronoun use.

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