Abstract
BackgroundThe global incidence in the treatment of transgender people is increasing. During the COVID-19 pandemic, many consultations had to be cancelled, postponed, or converted to a virtual format. Telemedicine in the management of transgender health care could support physicians.ObjectiveThe aim of this study was to analyze the acceptance, use, and barriers of telemedicine in transgender health care in times of SARS-CoV-2 in Germany.MethodsThis prospective cross-sectional study was based on a survey of gynecological endocrinologists and transgender patients undergoing gender-affirming hormone treatment in Germany during the COVID-19 pandemic. Descriptive statistics were calculated, and regression analyses were performed to show correlations.ResultsWe analyzed responses of 269 transgender patients and 202 gynecological endocrinologists treating transgender patients. Most believed that telemedicine was useful. Physicians and patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they did not currently use telemedicine, although they would like to do so. Patients and physicians reported that their attitudes toward telemedicine had changed positively and that their use of telemedicine had increased due to COVID-19. The majority in both groups agreed on the implementation of virtual visits in the context of stable disease conditions. In the treatment phases, 74.3% (150/202) of the physicians said they would use telemedicine during follow-ups. Half of the physicians said they would choose tele-counseling as a specific approach to improving care (128/202, 63.4%). Obstacles to the introduction of telemedicine among physicians included the purchase of technical equipment (132/202, 65.3%), administration (124/202, 61.4%), and poor reimbursement (106/202, 52.5%).ConclusionsTelemedicine in transgender health care found limited use but high acceptance among doctors and patients alike. The absence of a structured framework is an obstacle for effective implementation. Training courses should be introduced to improve the limited knowledge of physicians in the use of telemedicine. More research in tele-endogynecology is needed. Future studies should include large-scale randomized controlled trials, economic analyses, and the exploration of user preferences.
Highlights
The global incidence in the treatment of transgender people is increasing
Patients and physicians reported that their attitudes toward telemedicine had changed positively and that their use of telemedicine had increased due to COVID-19
This study explored the acceptance, use, and barriers of telemedicine in times of SARS-CoV-2 in transgender health care in Germany, as well as how the medical and mental health care of this special group of patients can be improved by the use of telemedicine applications
Summary
The global incidence in the treatment of transgender people is increasing. Approximately 15,000 to 25,000 persons in Germany are affected [1]. As a socially and medically vulnerable group, transgender people face numerous inequalities in terms of health and mental health problems as compared to cisgender people [3]. The COVID-19 pandemic has exacerbated international health problems and is creating devastating mental health strains on a global scale for many populations. Transgender people today face problems related to social, physical, and mental well-being, as well as difficulties in accessing health care. Even before the COVID-19 pandemic, there were many barriers to accessing health care for transgender people, such as a shortage of skilled health professionals, resulting in very few transgender people receiving gender-specific surgery and hormone interventions, especially in low- and middle-income countries [4]. Inequalities faced by transgender people in politics and society, such as legislation based on binary gender norms, could increase the risk of disease and mortality during the COVID-19 pandemic [5]. Telemedicine in the management of transgender health care could support physicians
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