Transgender patients often travel long distances and pay more for less-than-competent medical care. But as doctors embrace virtual treatment models, those problems may soon be obsolete.

 

M, who is non-binary and transgender, first sought care for gender dysphoria at their local Planned Parenthood clinic in South Carolina. (Because M has not disclosed their transgender status at work, they requested anonymity for this story.) The staff there was very caring, they said, but the clinic was underfunded and understaffed, with a long waiting list for follow-up appointments. "It was almost like musical chairs," said M, "with more people than seats." When M began taking hormone therapy for gender transition, delays in care led to month-long lapses in hormone prescriptions, resulting in an emotional and physical roller coaste 

The demand for affirming, competent transgender care far outsrips what’s available, and in rural areas, physicians able to provide that care are often fewand far between. By bringing doctors as close to patients as their nearest high-speed internet connection, telehealth offers a potential solution to that gap.

On the whole, transgender people travel further and receive less insurance coverage for their healthcare than do other sexual minorities. A study of rural sexual minorities found that 14 percent of transgender and non-binary people lived more than an hour's drive from their primary care providers, compared to only 5 percent of their gay, cisgender counterparts. And respondents to the 2015 US Transgender Survey said they were more likely to travel long distances for transition-related care than for routine care.

Other studies have show that transgender people were much more likely than cisgender people to have no health insurance, and about a quarter of those responding to a question about barriers to care reported the cost of gender-confirmation therapy (including hormonal and/or surgical therapy) was the main problem in not receiving it.

Once they make it into a provider's office, transgender patients are likely to have a negative experience related to their transgender status. According to the US Transgender Survey, one third of respondents who had seen a healthcare provider in the past year reported having a negative experience with a provider related to being transgender, and almost a quarter said they'd avoided seeking needed health care due to fear of being mistreated on the basis of their gender identity.

The American Academy of Family Physicians and other associations of primary care physicians are increasingly encouraging their members to provide transition-related care to patients with gender dysphoria. But many unspecialized physicians hesitate, citing fear of making mistakes and lack of knowledge, and in some cases, acknowledging bias.

As a result of all of these factors, transgender people living in rural and exurban areas are often faced with a vacuum of physicians willing to perform the bread-and-butter work of transition-related care: prescribing and adjusting hormone replacement therapy and related medication, ordering and reviewing laboratory results, responding to concerns about medication side effects, and monitoring patients' overall health within the context of transition. And while medical educators are beginning to catch up with the demand for trans-competent doctors, there’s still a long way to go.

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