Telehealth is the key to transsexual health care

Trans and gender diverse youth across the country are scared, struggling, and dying, and it’s our responsibility to address this crisis.

We know that gender-affirming health care improves the health and well-being of transgender and gender-diverse youth. Despite this, several states, including Texas, Florida, and Alabama, are doing what they can to make life-saving gender assistance illegal.

At the same time, the COVID pandemic has shown us that healthcare is not limited by geography; many health systems have expanded their telemedicine offerings. As clinicians in Massachusetts, where gender-affirming health care remains more accessible than elsewhere, we believe there are many ways clinicians can use telemedicine to address growing gaps in vital services, particularly mental health services, to help young, gender different people need and deserve.

At Transhealth Northampton, where one of us (Ducar) is Chief Executive Officer, we have been able to provide life-saving support to over 100 transgender and intersex people in the past few months with the help of a Community Health Worker and Community Engagement Specialist. Through in-person and telehealth services, our limited but growing primary care and mental health providers provided life-saving care to more than 1,000 people across New England in our first year, including in rural areas where gender-affirming care has historically been limited. Now that Massachusetts is expanding protections for gender-specific care, we’re ready to extend those social supports and care to young people of all genders, regardless of zip code.

Gender-affirming care is more than hormones and surgery, and there are concrete steps that hospitals, academic medical centers, ambulatory care networks, and health insurance companies can take to support youth and families in states that prohibit medical and surgical gender-affirming. treatment. . Helping these young people is, at a minimum, our responsibility to ensure that they grow up safe and confident. And, unfortunately, our ability to help can be a matter of life or death, primarily because transphobic laws make their way through the court system and these children and their families are needlessly stigmatized or even criminalized.

First, health care systems must invest in social and mental health support. Recent data shows that more than half of transgender and gender diverse youth have attempted suicide. This is about three times more than the national average. In the age of telemedicine, facilities can offer vital online gender confirmation support to youth and families by creating telemedicine services and online support groups (like ours). These services can be a lifeline for families in states where foster care is banned, as well as for people in more isolated, rural areas of the country. For hospital administrators who question the value of providing these services, we remind you that providing care that prevents suicide is far less expensive than treating attempts.

Support groups that are clearly not providing clinical care, like Transhealth, are inexpensive. These are different from clinic visits, which provide primary care or therapy and are paid for by insurance. They can be led by trained moderators who don’t need a license in every state where assistance is provided, and who may be transgender themselves. This is especially true because there are far fewer barriers to becoming a peer supporter than there are to obtaining a medical or nursing degree. Creating virtual peer support groups also provides meaningful work for transgender and gender diverse facilitators and gives youth the opportunity to see people like them thrive. Although such support groups are not a substitute for clinical care, insurers are increasingly willing to reimburse them. They can be offered in places where gender-affirming clinical care has been prohibited, and they can be offered to people regardless of geography. The costs of expanding them to reach underserved youth and families would be low.

Second, hospitals in states that prohibit the provision of gender-affirming medical care must expand the range of support services beyond their walls. Transgender youth and families with financial resources may travel out of state to get the care they need, making low-income families disproportionately vulnerable to the effects of treatment denials. Many hospital systems recognize that by supporting the so-called social determinants of health—housing, income, food, education, and employment—they improve the health of their neighbors. Backed by hospitals and insurance companies, funds could be provided to families affected by the ban on gender-affirming care, including travel expenses to medical facilities in states where the full range of gender-affirming care is available. Many employer health plans have already begun to do this for other types of health care that have been politicized, such as abortion.

Third, health care systems should offer legal assistance through medical-legal partnerships. Families in states that have tried to ban gender-specific care have already run into legal challenges. They will need support related to these new laws, but individual legal aid is expensive. Health facilities already work with lawyers to provide guidance on non-discrimination, employment, criminal law and child protection, and they can expand these services outside the state. Lawyers can help address privacy concerns by informing patients and families that they do not have to answer questions from law enforcement in health care settings and that health information cannot be released without consent.

Fourth, health researchers should study and document the consequences of treatment prohibition. Health care systems, especially medical schools and academic hospitals, routinely collect data and monitor adverse outcomes, including those resulting from public LGBTQ policies. In a recent survey, nearly seven out of eight transgender and gender-diverse teens indicated that anti-LGBTQ legislation in the US had worsened their mental health. By collecting reliable data, sharing it widely but appropriately, and using this research to communicate the real stories of youth and families, researchers have a powerful platform for policy change.

As an administrator or health care provider, you may not feel obligated to help transgender or gender diverse youth, especially if they are out of state. We disagree. Geography doesn’t matter; the duty to help a child in one’s community is the duty to help children everywhere. The cost of inaction is well documented: gender diverse youth whose needs are neglected struggle with mental health. They try to commit suicide.

When governments restrict access to gender-affirming health care, it goes against scientific evidence and puts lives at risk. As health care providers, we have an obligation to provide care based on evidence-based guidelines, regardless of geography. When we expand our understanding of gender-affirming care to include telemedicine support beyond hormones and surgery, many more doctors and health systems will be able to help transgender and gender diverse youth and their families.

This is an analytical article and the views expressed by the author(s) are not necessarily those of the author(s). Scientific American.

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