Telemedicine for Gender-Affirming Medical and Surgical Care: A Systematic Review and Call-to-Action

Stoehr, Jenna R.; Jahromi, Alireza Hamidian; Hunter, Ezra Leigh; Schechter, Loren S.

doi:10.1089/trgh.2020.0136

Cited by 24 publications

(23 citation statements)

References 66 publications

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“…The main strength of our systematic review is that, to our knowledge, it is the first of its kind to assess the current state of research on various e-health sub-concepts that could improve trans health care. Telemedicine is gradually gaining interest following similar reviews [50], but our systematic review is the first to provide a comprehensive overview of e-health with various sub-concepts and their effectiveness, acceptability, and feasibility when used in trans health care. Implementation of e-health in trans health care is new, and although this field is growing, evaluation research has been sparse.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Need for Inclusive Consideration of Transgender and Gender Diverse People in E-Health Services: A Systematic Review

Renner

Täuber

Nieder

2022

JCM

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Many transgender and gender diverse (TGD) people use the internet to find ways out of isolation, network, and share information on health-related topics. Thus, e-health services could reduce the health burden of TGD people and facilitate access to health care. Following the PRISMA guidelines, we conducted a systematic review on e-health approaches that could improve trans health care (i.e., services directly for TGD people or training programs for health care professionals, HCPs) and their effectiveness, acceptability, and feasibility. We searched PubMed, Web of Science, and PubPsych databases for publications from January 2000 to June 2021 with final updates before publication. The systematic review identified e-health services across 27 studies from 8 different countries. Few studies evaluated e-health services exclusively for TGD people. However, use of an e-health service was found to be effective and beneficial: TGD people improved in health-related outcomes, and HCPs improved in professional expertise. Service users find e-health services helpful and easy to integrate into their daily lives. Recommendations for further development of e-health services in trans health care are provided. In the future, given the rapidly evolving e-health research and care field, new treatment approaches for TGD people should be subject to ongoing evaluation and development.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Need for Inclusive Consideration of Transgender and Gender Diverse People in E-Health Services: A Systematic Review

Renner

Täuber

Nieder

2022

JCM

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“…Even before the onset of the COVID-19 pandemic, a study showed that trans youth were interested in receiving telemedicine, particularly for ongoing care and monitoring [23]. There is now increasing evidence to support the feasibility of telemedicine in gender-affirming care to increase access to care [24][25][26][27]. In studies focused on experiences and attitudes, trans youth and families have had positive perceptions of virtual gender-related health care during the COVID-19 pandemic [28,29].…”

Section: Introductionmentioning

confidence: 99%

Usability of Virtual Visits for the Routine Clinical Care of Trans Youth during the COVID-19 Pandemic: Youth and Caregiver Perspectives

Silva

Fung

Irvine

et al. 2021

IJERPH

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We evaluated families’ perspectives on the usability of virtual visits for routine gender care for trans youth during the COVID-19 pandemic. An online survey, which included a validated telehealth usability questionnaire, was sent to families who had a virtual Gender Clinic visit between March and August 2020. A total of 87 participants completed the survey (28 trans youth, 59 caregivers). Overall, usability was rated highly, with mean scores between “quite a bit” and “completely” in all categories (usefulness, ease of use, interface and interaction quality, reliability, and satisfaction). Caregivers reported higher usability scores compared to trans youth [mean (SD) 3.43 (0.80) vs. 3.12 (0.93), p = 0.01]. All families felt that virtual visits provided for their healthcare needs. A total of 100% of youth and caregivers described virtual appointments as safer or as safe as in-person visits. A total of 94% of participants would like virtual visits after the pandemic; families would choose a mean of two virtual and one yearly in-person visit with a multidisciplinary team. Overall, virtual gender visits for trans youth had impressive usability. Participants perceived virtual visits to be safe. For the future, a combination of virtual and in-person multidisciplinary visits is the most desired model.

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“…And an "either/or" approach to such questions overlooks the possibility of telehealth-supported specialist consultations and similar hybrid models (4). Emerging evidence shows promise in the acceptability, usability, patient satisfaction, and cost-effectiveness of gender-affirming telehealth, particularly among TGE youth who feel unsupported by their parents (3,4).Where TGE eHealth in the COVID era departs most radically from the past is in its abrupt, recent, turn toward venture capital (VC)-backed commercialization. Exemplifying this turn are the telehealth services Folx and Plume.…”

mentioning

confidence: 99%

“…In the U.S., the Centers for Disease Control and Prevention recommended the suspension of in-person appointments. Federal regulations that had restricted reimbursement for telehealth services and barred cross-state practice were relaxed ( 3 , 4 ). These changes vastly expanded access to telemedicine, permitting TGE young people to access primary care, counseling, and GAHT initiation virtually, or via hybrid models of care, typically extensions of established providers ( 3 , 4 ).…”

mentioning

confidence: 99%

“…Federal regulations that had restricted reimbursement for telehealth services and barred cross-state practice were relaxed ( 3 , 4 ). These changes vastly expanded access to telemedicine, permitting TGE young people to access primary care, counseling, and GAHT initiation virtually, or via hybrid models of care, typically extensions of established providers ( 3 , 4 ). Presently, telehealth cannot replace key aspects of in-person (particularly pre-surgical) consultation ( 3 ), which most TGE youth prefer for GAHT initiation ( 4 ).…”

mentioning

confidence: 99%

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mHealth for transgender and gender-expansive youth: an update on COVID, venture capital, and the cultural in/congruence of revenue-driven sustainability models

Skeen¹,

Cain²

2022

mHealth

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Interactive communications technologies (ICTs) are key sites of self-discovery, community formation, health education, and creative expression among the 0.7-3.2% of young people who identify as transgender and genderexpansive (TGE). mHealth interventions intended for TGE users are situated within-and, increasingly, informed bythis rich online milieu. ICTs permit socially isolated users to transcend the limitations of their physical environments, in which TGE social bonds, gender-affirming hormone therapy (GAHT) providers, or physical safety, may be lacking. This is particularly true of TGE youth, who may lack autonomy or in-person support (1). A diverse, innovative range of ICT interventions serves the genderaffirmation needs of TGE users. As noted by Skeen et al. (1), these interventions can be classified along distinct lineages: (I) academic medicine, often via NIH-funded clinical trials; (II) human-computer interaction, user experience (UX) design, and adjacent subfields; and (III) TGE-led community technologies, often developed via hackathons and crowdfunding.Since the initial, July 2020, publication of that scoping review (1), upheavals have occurred within TGE mHealth, with implications for mHealth self-sustainability, broadly. Most can be traced to the COVID pandemic, which disproportionately burdened marginalized subpopulations. Jarrett et al. surveyed transgender and nonbinary respondents across 76 countries from April-August 2020, 55% of whom reported diminished access to gender-affirming care due to the pandemic; 38% were less able or unable to live in accord with their genders at all (2). In the U.S., the Centers for Disease Control and Prevention recommended the suspension of in-person appointments. Federal regulations that had restricted reimbursement for telehealth services and barred cross-state practice were relaxed (3,4). These changes vastly expanded access to telemedicine, permitting TGE young people to access primary care, counseling, and GAHT initiation virtually, or via hybrid models of care, typically extensions of established providers (3,4). Presently, telehealth cannot replace key aspects of in-person (particularly presurgical) consultation (3), which most TGE youth prefer for GAHT initiation (4). And an "either/or" approach to such questions overlooks the possibility of telehealth-supported specialist consultations and similar hybrid models (4). Emerging evidence shows promise in the acceptability, usability, patient satisfaction, and cost-effectiveness of gender-affirming telehealth, particularly among TGE youth who feel unsupported by their parents (3,4).Where TGE eHealth in the COVID era departs most radically from the past is in its abrupt, recent, turn toward venture capital (VC)-backed commercialization. Exemplifying this turn are the telehealth services Folx and Plume. Forgoing any brick-and-mortar presence, both offer GAHT initiation, maintenance (4), and wraparound care tailored for sexually and gender-diverse patients, Letter to the Editor

show abstract

Telemedicine for Gender-Affirming Medical and Surgical Care: A Systematic Review and Call-to-Action

Cited by 24 publications

References 66 publications

Need for Inclusive Consideration of Transgender and Gender Diverse People in E-Health Services: A Systematic Review

Need for Inclusive Consideration of Transgender and Gender Diverse People in E-Health Services: A Systematic Review

Usability of Virtual Visits for the Routine Clinical Care of Trans Youth during the COVID-19 Pandemic: Youth and Caregiver Perspectives

mHealth for transgender and gender-expansive youth: an update on COVID, venture capital, and the cultural in/congruence of revenue-driven sustainability models

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