番茄社区

MIAMI -- Some telemedicine companies offering gender-affirming hormone treatment offered an affordable alternative to traditional care models, a researcher reported at the Sexual Medicine Society of North America (SMSNA) annual meeting.

A review of available services from six direct-to-consumer platforms -- Folx Health, True U Clinic, QueerDoc, Q, TransClinique, and Plume -- found that all met World Professional Association for Transgender Health (WPATH) standards of informed consent for gender-affirming hormone therapy, and standards for regular laboratory work for treatment monitoring.

All offered hormone therapy and legal assistance with name changes. Some offered other gender care services, like puberty blockers, medical letters of support for surgery, and surgery referrals, according to Erin Jesse, MD, a urology resident at the University Hospitals Cleveland Medical Center.

Notably, these telemedicine platforms may increase access to cost-effective and culturally competent care for uninsured transgender and gender-diverse people: First-year costs for hormone therapy without insurance ($1,022-$1,428 for oral estradiol and $1,184-$1,668 for intramuscular testosterone therapy) were similar to what they would be at a tertiary center used for comparison ($1,184 for estradiol and $1,216 for testosterone).

Most of the direct-to-consumer platforms do not accept private insurance or Medicaid, which would be cost-prohibitive for many prospective patients, while the comparison tertiary center did accept insurance. But, Jesse noted, the convenience of the online-only platforms might make it worth it for many patients.

"There can be a lot of distress that comes from even just going into a doctor's office -- maybe it's your first time, you're not sure if that physician is familiar with transgender care, maybe you're not sure what other patients in the office are going to think," Jesse told 番茄社区.

Getting healthcare from home, virtually, is a "huge benefit" for the patients who are uncomfortable or feel a lot of discrimination in an office setting, Jesse said. She added that online platforms could be more appealing to rural patients and younger or more tech-inclined people.

For the analysis, Jesse and her fellow researchers queried Google to find U.S. gender-affirming care platforms in March of 2022. Payment models on the online platforms included pay-per-service or monthly membership, and researchers estimated costs for the tertiary center using an online cost estimator.

The study did not evaluate platforms based on WPATH guidelines beyond informed consent and lab work because these qualities were not readily assessed from looking at the websites.

Jesse noted that none of the six services offered mental or behavioral health services.

Part of this separation, along with the informed-consent model, could be to reduce the stigma associated with gender diversity, or the assumption that it goes hand-in-hand with mental illness. In some modalities of care, transgender patients are required to undergo a mental health evaluation to access gender-affirming care.

Though there's a high rate of gender dysphoria and mental health comorbidity, Jesse said, "If you don't have mental health comorbidities that are a problem, or interfering in your life, then having to jump through hoops and going and getting a mental health evaluation is just extra stigma, it's extra steps. It's almost demeaning to the patient."

"For these specific platforms, [gender dysphoria] is what these doctors treat, and so that's what they're good at, and that's what they're comfortable treating," said Jesse. "They draw a line in the sand basically."

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