How telemedicine makes health care accessible for transgender communities in rural America

May 18, 2020


The town of Zeeland, Mich., sits on the Eastern shores of Lake Michigan. With a population of approximately 5,300, Zeeland doesn’t generate much national attention. In fact, according to the town’s Wikipedia page, Zeeland’s  most notable occurrences are Zeeland High School alum Jim Kaat developing into an MLB All-Star, Zeeland West High School claiming two Division III football titles and a high school assistant teacher suspending a student for wearing a Korn t-shirt.

However, despite the relatively few controversies found in Zeeland, one resident states the town still hasn’t fully embraced its transgender community.

Roselyn London, age 20, lives as a transgender woman. But, according to London, residing in Zeeland creates obstacles that have left her transition suspended in limbo.

Despite embracing her gender identity 3 ½ years ago, London is not on hormone replacement therapy. She also hasn’t made her family aware of her gender decision to live as a woman, only beginning her social transition among her closest friends.

“My family doesn’t know,” said London. “They have hints, just like casual things lying around or something I forget to put away, like makeup or clothes.I’m too scared to tell my family, but if they were to come to me and say, ‘Hey, we know,’ I’d be able to tell them.”

For much of the transgender community, the fear of coming out to their family, friends and peers operates as a roadblock on their way to adjusting. However, for individuals like London, it isn’t the only obstacle. For transgender people who live in rural areas, looking into the process of starting their transition once ready leads to more anxiety.

“Most of the places that I’ve found that are close to me are actually not close to me at all,” said London. “They’re three hours in one direction.”

Unfortunately, for transgender men and women residing in rural areas, this reality is all too common.

Rural transgender communities face daunting commutes to seek care tailored to the specific needs of transitioning individuals. A report released by the Movement Advancement Project (MAP) in 2019 found that 43% of transgender individuals in rural areas travel at least 50 miles one way in order to see their transgender-related medical care provider. Of that percentage, 27% commute at least 75 miles one way.

“Who wants to drive six hours by themselves?” said London. Such long commutes often interfere with patients’ professional, academic and social responsibilities.

For residents of rural America, finding a doctor that is willing and able to provide both effective and responsible trans-specific care remains a challenge. Most medical schools don’t provide sufficient education on the subject of trans-health, limiting the trans-health medical community to only the most self-motivated practitioners.

According to the National Transgender Discrimination Survey Report on Health and Healthcare, 19% of the sample surveyed reported that they were refused care based on their gender identity. Furthermore, 28% of those questioned stated they suffered harassment in medical settings while 50% reported having to instruct their medical providers about transgender care.

“Being transgender is about as common as Type 1 diabetes, and it’s just assumed that we all learned about Type 1 diabetes and treat it,” says Dr. Izzy Lowell, who specializes in transgender and gender nonconforming care.

Lowell also opened and runs QMed, a clinic that provides gender-affirming care, or care specifically specializing in gender identity. QMed practices telemedicine, which is a primarily online form of care via video conference.

With telemedicine, Lowell’s patients are not required to come into the clinic as often as patients electing face-to-face care. Most of what Lowell practices can be done online, allowing her to send prescriptions straight to her patient’s preferred pharmacy.

Because telemedicine is an online practice, it decreases travel times and travel costs, creates a safer space for patients and provides a more convenient form of healthcare from doctors eager to serve the LGBTQ+ community.

Unfortunately, due to existing laws and regulations, Lowell’s practice is limited to the American Southeast, where she is licensed in five states–North Carolina, South Carolina, Alabama, Georgia and Tennessee.

“We don’t have a national license, and we can’t work across state lines, so it becomes a lot more limited than we want it to,” says Dr. Crystal Beal, who opened and runs a similar clinic called QDoc across the Pacific Northwest.

Accessibility and the ability to expand remains a hurdle for telemedicine practitioners as doctors must be licensed in the states their patients are located.

However, in areas that can be covered by telemedicine, clinics and patients are thriving, barring a few obstacles.

For e-visits to be efficient and practical, patients need access to broadband and high speed internet, which is a problem within low-income communities. However, in some cases, a simple phone call may suffice.

QMed serves over 1,500 patients and is addressing a lot of the growing needs of the Southeast. QDoc in the Pacific Northwest is an exclusively online service, able to see and treat patients no differently than a brick-and-mortar clinic while creating a safe environment for their patients.

“Eighty percent of the diagnosis we make in medicine is based on someone’s story,” says Beal. “It is not the physical exam, it’s not me putting my hands on my patients, it’s what they’re telling me, what I’m hearing from them and what questions I’m asking for clarification…A lot of the time, they don’t want to be touched or examined, so having a video screen between you, and being able to shut that screen and peace out if you feel unsafe, I think is very beneficial for them.”

Julie Jenkins, a nurse practitioner at Maine Family Planning, echoes Beal’s thoughts. “There’s this idea that if you’re doing telemedicine that you’re not doing good care,” said Jenkins. “It’s just not true. You’re giving people so much more access that they otherwise wouldn’t have in their own communities.”

Unfortunately, despite the emergence of telemedicine and specialized care aimed at assisting the transgender community, needs are still going unmet around the country. There are a limited number of clinics that provide telemedicine services, but these organizations remain in their embryonic stages.

Nevertheless, Beal states her hope that the limitations imposed by the novel coronavirus COVID-19 pandemic result in an increased emphasis on specialized care, both within the transgender community and beyond it.

But until then, transgender individuals like London are still not covered. However, telemedicine is starting to fill in the healthcare gaps in the LGBTQ community.

“That would make things 95,000 times easier,” says London.

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