In a 7-month program involving five interdisciplinary clinical teams41, participants reported that the teleconsultation program was highly beneficial and contributed to improvements in team dynamics. Similarly, didactic sessions covering various topics such as hormone therapy initiation, primary care issues, advocacy, and psychotherapy were found effective in meeting learners’ objectives and enhancing their confidence in treating transgender veterans42.
This scoping review examined telemedicine services within the LGBTQIA + community, focusing on GAC, mental health, STI, and HIV care, along with patient and provider satisfaction, and telemedicine use for training and interdisciplinary consultations. During COVID-19, remote methods like phone calls and video conferencing became crucial, whereas pre-pandemic options, particularly for transgender healthcare, were limited due to inadequate education and discrimination. The introduction of telemedicine during COVID-19 led to increased patient utilization and reduced delays in providing GAC. Appointment completion rates improved, cancellations decreased, and no-show rates were lower compared to in-person visits, especially in rural areas.
Similar findings were observed by Deguzman et al. and can be mainly attributed to easier accessibility, which proved to be a significant factor, with patients in rural areas, distant from healthcare facilities, exhibiting higher attendance rates for telemedicine appointments compared to their urban counterparts. This highlights telemedicine’s advantage in offering quick and accessible care from home. However, findings from another study revealed slight differences in trends among urban populations. Specifically, a lower percentage of urban patients completed their appointments post-COVID-19 compared to the pre-pandemic period. In contrast, patients from rural areas showed an increase in appointment completion rates following the widespread adoption of telemedicine. This discrepancy is likely attributed to the fact that individuals in remote and rural settings benefited more from telemedicine, as it helped overcome geographical and travel-related cost barriers to healthcare access.
Telehealth was especially preferred for services like hormone refills and lab result monitoring, as it reduces in-person visits and addresses distance and transportation barriers. Similar findings by Sequeira et al. indicated that most gender-diverse youth felt satisfied and comfortable with telemedicine. However, limitations in the included studies highlight important factors to consider when interpreting results. For instance, one study used no-show rates to assess access to care but overlooked issues like scheduling challenges, inadequate parental support, and lack of awareness about available services. However, grouping solely by medical records may have led to misclassification, especially for visits related to eating disorders and gender health, potentially underestimating no-show rates in these populations. Moreover, most studies relied on system-level data, lacking patient-level insights, which limited understanding of individual experiences, particularly for transgender patients seeking care during the pandemic. Additionally, data were sourced from specific, select community-based clinics, limiting generalizability to other patients receiving care in other healthcare settings, such as private practices or academic institutions.
Only a few studies included subgroups within the LGBTQIA + population, such as intersex, asexual, and indigenous individuals, resulting in significant underrepresentation. Lack of diversity in samples studied generally means that findings are not generalizable, and some studies might inadvertently fail to represent various healthcare needs and barriers. Most telehealth intervention studies lacked racial and ethnic diversity, and thus their applicability was limited to non-racially or ethnically diverse populations.
Another important point to consider is thatsome of these studies involved already experienced participants in telehealth which biases their acceptance of the interventions. The participant profiles have overlooked major factors such as intimate partner violence and relationship dynamics leaving much that could be present in the depth of the findings. Critically evaluating these limitations highlights the need for more inclusive research designs that account for biases in study design, sample selection, and demographic representation.
Timely provision of telemedicine services helped improve overall mental health, as demonstrated by reduced rates of depression and suicidal ideation, as well as improved mental health scores. These results can be attributed to a positive health balance due to timely administration of key interventions.
A noticeable positive trend towards the likelihood of accessing telemedicine services for HIV testing and counseling was observed, especially in the latter half of the pandemic. This trend aligns with other data, such as a study by Homkhan et al. on transgender women, which found telemedicine to be an effective alternative for accessing HIV testing, particularly among intravenous drug users. The major reason for these findings could be the increased acceptance, resulting in patients feeling more comfortable and less concerned about confidentiality issues because of their remote nature. The patients felt more secure and were able to freely share their past sexual history without fear of being judged.
Similarly, previous studies, such as Atkinson et al., have shown that many individuals in sexual minority groups perceive seeking mental or behavioral healthcare as stigmatizing. Telemedicine provides a more comfortable, judgment-free platform for accessing necessary care. Additionally, intravenous drug users and transgender youth demonstrated a greater preference for telemedicine visits and higher acceptance of remote HIV testing over in-person services. In contrast, Stekler et al. found no difference in STI treatment and screening rates between telemedicine users and in-person patients, possibly due to better healthcare access in that study setting and the advantages of building provider-patient relationships through face-to-face interactions.
Our study shows that the satisfaction level with the use of telemedicine services varies depending on the type of services provided, according to both the patients and physicians. Studies conducted by Lucas et al. and Gava et al. revealed similar findings, which may be attributed to easier access to telemedicine, especially for individuals who cannot access care otherwise. Regarding mental health services, the results demonstrated significant improvements in patients’ mental health scores compared to individuals receiving no care at all).
In terms of screening for STIs, patients generally found telemedicine services to be satisfactory, and a similar trend was observed by Rotheram et al. These findings could be attributed to the added patient benefits, such as both pre- and post-testing counseling in telemedicine consultations, providing opportunities to learn and discuss sexual health more comprehensively than traditional healthcare approaches. It is noteworthy that black sexual minority groups reported satisfaction with virtual focus groups targeting HIV prevention, feeling more included and at ease around their own people.
Telemedicine serves as a valuable tool for training and interdisciplinary services; several studies have demonstrated the pivotal role that telemedicine can play. Interestingly, the utilization of telemedicine for interdisciplinary consultation and training has been shown to significantly enhance the quality of care among veteran groups. These consultations facilitated the involvement of multiple disciplines, leading to a more comprehensive approach to medication, hormonal therapy, and psychiatric support. The training programs also demonstrated an increase in confidence among healthcare providers in delivering services to transgender veterans in a more cooperative manner and with better teamwork.
Interdisciplinary telemedicine consultation has emerged as a valuable tool to enhance provision of comprehensive care to transgender individuals. Telemedicine has proved to be a vital tool for communication with specialists primarily dealing with GAC. Sessions covering various topics, including hormone therapy initiation, primary care issues, advocacy, and psychotherapy, were found to be extremely effective. It also facilitated the establishment of a holistic approach with peer support networks, a patient-centered approach to care, and a safe space to address concerns ranging from medication management to mental health evaluations, enabling individuals to learn from other people’s experiences. This interdisciplinary approach not only enhances individual provider knowledge but also fosters a collaborative environment where providers can learn from each other’s experiences and expertise.
However, telemedicine is associated with its idiosyncratic challenges. Our review revealed that the primary challenge faced by patients is difficult relationship dynamics with healthcare providers. Silva et al. reported similar issues, which were attributed to obstacles in establishing a doctor-patient relationship due to the remote nature of telemedicine care services. For some patients, receiving HIV screening results via a phone call was inconvenient, as the timing was not suitable for receiving the results and they would opt for in-person services. Additionally, technical difficulties are often encountered with the use of telemedicine, leading to deviations from the main objective of the appointment, which is to provide care. Some patients also expressed hesitancy about video consultations due to privacy concerns.
Further, patients were concerned about the quality and safety of video visits being compromised and expressed concerns about potential misgendering. Some transgender youth requested to disable the camera during the consultation for fear that seeing their image may trigger body dysphoria. Hertling et al. showed that a handful of patients requested that additional healthcare providers be present during teleconsultation, which made them more comfortable. Thus, telemedicine may not be the optimal mode of consultation and communication for certain patients. Unsurprisingly, teleconsultations were preferred by patients residing longer distances from healthcare facilities or in rural areas. Conversely, patients in urban areas and those with easier access to healthcare preferred in-person services. However, overall data points towards the utility and massive potential of telemedicine services among patients with both mental and chronic health conditions.
The ethical considerations of telemedicine use are complex and merit in-depth examination, particularly with regard to LGBTQIA + people. The possibility of digital privacy breaches is a major concern, as it could expose private health data to hackers or unauthorized access, potentially leading to discrimination, particularly against patients in marginalized communities. This highlights the need for more stringent security protocols in telemedicine, especially for these vulnerable populations. Additionally, obtaining informed consent in telemedicine can be challenging, especially when there are linguistic and cultural barriers, or when patients may not fully understand the risks involved.
Ensuring clear and culturally appropriate consent procedures is essential for an inclusive telemedicine experience. Culturally competent care, which includes avoiding misgendering and addressing specific health concerns of LGBTQIA + patients, is crucial. Research shows that implementing culturally appropriate telemedicine can significantly improve patient outcomes and trust. Transparency, community involvement in telehealth design, and ethical frameworks prioritizing patient autonomy and safety are vital to addressing ethical issues. Involving LGBTQIA + communities in developing telemedicine services ensures these initiatives meet the needs of underserved groups. Additionally, incorporating targeted curricula in medical schools and residency programs to enhance cultural competence and ethical communication is highly beneficial.
Our study indicates that physicians generally recognize the value of telemedicine, particularly for follow-up and monitoring, though they prefer in-person consultations for invasive procedures, aligning with Hertling et al.. To enhance telehealth services for the LGBTQIA + community, we recommend several policy approaches: advocating for expanded telehealth services and insurance coverage, allocating funds for LGBTQIA+-specific telemedicine initiatives, and establishing inclusive telehealth guidelines to ensure all patients feel supported, respected, and safe in their care.
Strengths.
This study is among the first to broadly explore telemedicine’s impact on LGBTQIA + healthcare, providing insights for future research and policy development. It systematically examines gender-affirming hormone therapy, surgical consultations, mental health services, and HIV/STI testing, offering a comprehensive assessment of telemedicine’s applicability in meeting diverse healthcare needs. By including studies on transgender individuals, gender-diverse youth, non-binary persons, MSM, and transgender veterans, the review enhances the generalizability of its findings and highlights telemedicine’s potential to address healthcare disparities among marginalized groups.
Analyzing data from before and during the COVID-19 pandemic reveals trends in healthcare delivery preferences and highlights telemedicine’s evolving role. The review’s use of diverse methods — surveys, interviews, retrospective analyses, and telemedicine interactions — strengthens its conclusions. Emphasizing patient and provider satisfaction, along with mental health outcomes, underscores a commitment to patient-centered care and improving health-related quality of life for LGBTQIA + individuals.
Despite the strengths, several limitations were noted in the reviewed studies. Data constraints from electronic health records often lacked details about patient experiences, limiting understanding of telemedicine choices. Many studies with smaller sample sizes provided more qualitative insights, often overlooking diversity in race and urban/rural contexts.Survey completion rates varied, with some patients failing to complete surveys or being surveyed at different care stages, potentially affecting outcomes.
Accessibility issues such as lack of internet access, affordable devices, and transportation barriers contributed to missed appointments. Self-selection bias was common, with participants often having prior research involvement. Recall and social desirability biases were also reported. Gender identification expression was restricted in studies using multiple-choice online surveys.
Disruptions during COVID-19 and temporary virtual care policies complicated the analysis, especially with regional differences in pandemic severity. Some surveys were completed by family members instead of trans youth, affecting interpretation. Privacy concerns for adolescents were often not addressed, potentially impacting findings. Most surveys were conducted in the United States, limiting representation of areas with more conservative sexual health policies. However, a study in Italy, which was severely affected by the pandemic, reported higher telemedicine favorability.
Billability constraints and caps on virtual visits in some government administrations may also restrict telemedicine use. Lastly, the learning curve for telemedicine usability for both patients and providers is a potential limitation.
Our study highlights the wide range of healthcare services effectively delivered via telemedicine, including GAC, mental health support, and STI screening. Telemedicine acts as a vital lifeline for the LGBTQIA + community, often facing systemic barriers and discrimination in accessing care. To enhance its impact, future strategies should target marginalized subgroups. For example, specialized telehealth programs for rural transgender youth can close gaps in gender-affirming treatment and mental health support, while digital mental health platforms can assist non-binary individuals who face challenges with in-person affirming care.
Telehealth also improves access to specialized care for intersex individuals, regardless of location. However, many providers report insufficient training in telemedicine, emphasizing the need for comprehensive education programs tailored to its nuances. The significance of telemedicine extends beyond the COVID-19 pandemic, indicating its lasting role in healthcare delivery. While the future of telemedicine is promising, it’s crucial to address ongoing challenges like technology constraints, resistance, and digital inequality. Community outreach and education can help raise awareness of telemedicine’s benefits, while improving access to technology is vital for equitable healthcare in underserved areas. Ongoing training for healthcare providers on LGBTQIA+-affirming care will enhance patient experiences and foster inclusivity.
