Telemedicine in Transgender Care: A Twenty-First-Century Beckoning.

Abstract

The advent of telemedicine has undoubtedly revolutionized the practice of health care. With advances in photograph and live relay quality, and the ease of data transmission through the Internet, telemedicine has great potential in the field of plastic surgery. The majority of consultations in plastic surgery require visual diagnoses, thereby enabling telemedicine to help tackle issues of health care costs and accessibility.1,2 Telemedicine can help decrease patient travel and health care costs. Costa et al. described an average of 239 miles of travel avoided per visit for patients residing in the United States by using video teleconferencing for cleft lip/palate evaluations.3 At the same time, telemedicine-based approaches have been cited for having a high degree of accuracy.2,4 Engel et al. identified similar diagnostic accuracy between in-person examinations for free flap monitoring compared with remote smartphone photographic assessments.4 However, there is a paucity of literature focusing on the utility of telemedicine in the care of the transgender population. Despite the increasing social acceptance, gender-diverse people still face major challenges in access to appropriate health care.5–7 Thus, there is an urgent necessity to improve health care access for the transgender population.6,7 In 2017, Herman et al. found that approximately 1.4 million adults (0.6 percent of adults in the United States) and 150,000 youths (0.7 percent of the youths aged 13 to 17 in the United States) identify as transgender.8 Individuals who identify as transgender and seek medical or surgical transition require interdisciplinary health care involving multiple medical and ancillary services.6 Plastic surgeons play an invaluable role in gender-affirming operations in patients desiring these options.7,9 However, because of their complexity, these procedures are often limited to tertiary centers with specialized teams, which limits access to a large percentage of the transgender population.10 Many clinical assessments are amenable to telehealth, which can greatly facilitate health care access, decrease travel time, and reduce costs and wait times for these patients. Following gender-affirming surgery, there is a need for postoperative flap monitoring and assessment of wound healing.7,9 Scheduled postoperative telemedicine consultations would permit early identification of symptoms suggestive of complications. Furthermore, psychosocial issues continue after surgery and require periodic evaluation and support, which could be addressed through telehealth intervention. Recent literature has discussed the successful pilot implementation of telemedicine for providing transgender care in the Veteran’s Health Administration.6,11 These pilot studies reiterate the prospect of telemedicine in transgender care. However, the outcomes of telemedicine in the field of reconstructive surgery in this population are still lacking. In summary, both telemedicine and transgender care have been evolving over the past decade, particularly because of growing recognition and social awareness.7,12 Although telemedicine has been extensively adopted in plastic surgery2 and is starting to make steady inroads into transgender care,11 the cluster of these three fields has immense potential for revolutionizing the treatment of this population. Future studies should explore the effectiveness of telemedicine for improving outcomes and optimizing access to health care for this underserved population. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.