The Quiet Revolution in Trans Health Care

During the early months of the pandemic, I checked in with some trans people to see how social isolation was impacting their dysphoria. The results were mixed. For some, not being perceived and/or misgendered was a boon; others found the isolation well, isolating, and gave them way too much time to scrutinize the person looking back at them in the mirror.

But those were the early days of COVID, and it was too soon to tell if social distancing would result in a wave of cracked eggs and an uptick in trans people accessing hormone replacement therapy (HRT) for the first time. Since then, our crumbling empire’s approach to the pandemic has hugely overburdened our health-care system and discouraged people from seeking in-person care unless it’s absolutely necessary. Many providers also pivoted to using telemedicine whenever possible, including for transition-related health care. So while we don’t know how many trans people have “hatched” so far during the pandemic, almost a year later, we have enough data to confirm that a lot of people used telemedicine to access HRT in 2020.

“Throughout the COVID-19 pandemic, Planned Parenthood health centers have been working to expand telehealth services so that more patients can access critical health-care services online or by phone — including gender affirming hormone therapy (GAHT),” explains June Gupta, the Director of Medical Standards at Planned Parenthood Federation of America. “The number of patients seeking GAHT from Planned Parenthood increased 35 percent from 2019 to 2020, from over 16,000 patients in 2019 to almost 22,000 in 2020.”

Planned Parenthood is believed to be one of the largest providers of HRT in the country, so it’s not unreasonable to view this expansion of telehealth and increase in the number of trans patients as a somewhat representative national cross-section. But, as Gupta points out, correlation isn’t necessarily causation. “We don’t currently have enough data to see a correlation; however, we do hear patient feedback directly and through providers, and are seeing positive stories from patients accessing this care via telehealth,” she says.

I didn’t have to look far to find anecdotal evidence that access to telehealth services has lowered the barrier to care for trans people. My roommate Tess Hazel is a 32-year-old Brooklyn resident who started as a Planned Parenthood patient via telehealth last year, and subsequently began HRT through the organization’s informed consent model. “I mean, we’re in a pandemic,” they say when I ask them why they opted to go with telehealth to access hormones last year. “It’s definitely more appealing to have a telehealth option. I think in any normal moment, the telehealth versus in-person thing would have been less of consideration.”

Besides safety, Tess explains, the other major factor in choosing telehealth was that it’s easy. Because accessing HRT is a multi-step process, “telehealth is definitely more convenient for just consultations. It’s much less of an ask to hop on a video call through an app compared to traveling to an office — there are a hundred small tasks that need to be done in order to eventually get me to an office for an appointment. Doing them via telehealth really reduces the number of small tasks I need to navigate to talk to a doctor.”

It’s not just Brooklynite transsexuals benefitting from telehealth expansion either; trans people in small towns and rural communities are also having an easier time accessing care. “I feel like our service really took off, exponentially, once we started going to telehealth,” says Bhavik Kumar, the Medical Director for Primary and Trans Care at Planned Parenthood Gulf Coast, an affiliate that covers both Louisiana and Texas. After the affiliate started offering trans-specific care (including HRT) in 2019, it responded to the pandemic by quickly pivoting to offer those services via telehealth. By April, Kumar says telehealth “opened up the possibility for a lot of folks living in rural places, where they may not have a provider for trans care. They could stay at home and access that care in the comfort of their own home, and still get the care that they needed.”

“Unfortunately, for a lot of our trans patients, they’ve had a lot of bad experiences with the health-care system, including discrimination, being misgendered and so many other things,” Kumar continues. “So there’s a lot of anxiety and hesitation toward trying to access health care. And a lot of our patients have been surprised that we’re friendly and that they’ve had a good experience, which is great for us to hear. But we especially hear this from folks who live in more rural areas, mostly because we know that a lot of health-care providers are simply not trained in providing this type of health care.”

Of course, Planned Parenthood isn’t the only organization offering trans health care; plenty of queer health centers and local clinics have been prescribing HRT to the communities they serve for decades. But a new trend has also emerged in recent months: A wave of transition-related apps and services have been announced, and for the most part, immediately roasted by trans people on Twitter. (A few of these apps are obvious grifts and not worth getting into here — that’s what the Twitter takedowns are for.)

Some of these new services have the potential to offer more or less what you’d expect to get from a clinic. Folx and Plume both appear to be basically subscription boxes for HRT, and it’s possible they could benefit trans people without insurance or for whom the home delivery system makes physically obtaining medication more accessible. Plume membership is $99 per month, and monthly HRT from Folx will run you anywhere from $59 to $139 a month depending on your needs, plus additional costs for specific medications or at-home blood labs. (Being on HRT requires semi-regular blood tests.) That could be a good deal or wildly overpriced, depending on an individual’s health-care situation, dosage needs and countless other personal specifics — creating a market for the next app in the “trans-tech” space to help us comparison shop for ‘mones.

It’s whiplash-inducing for trans people to be seen as a lucrative demographic to market to (which doesn’t align with the self-reported data from trans people) while attacks on our rights continue across the country. By the same token, it feels unhelpfully cynical to condemn new attempts to connect trans people with necessary medical care when our current health-care system is literally just GoFundMe. And while there’s no perfect solution to making easy access to medical transition universal — Medicare for All would be a start — continuing to expand access to telehealth, and maintaining its use even after it’s safe(r) to commingle with other people in public, seems like one of the best tools we have.

“I definitely think there’s going to be a role for telehealth to continue,” Kumar confirms. “We’ve heard loud and clear from people that it makes it easier to access the health care that they need. Exactly how that will look in the future, I’m not sure, but I definitely think there will continue to be a need for telehealth.”

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Calvin Kasulke

Calvin Kasulke is a transsexual and a contributing writer at MEL. You can pre-order his novel Several People Are Typing here, and find him on Twitter at @cjkasulke.