mHealth for transgender and gender-expansive youth: an update on COVID, venture capital, and the cultural in/congruence of revenue-driven sustainability models

Simone J. Skeen, Demetria Cain
2021 mHealth  
Interactive communications technologies (ICTs) are key sites of self-discovery, community formation, health education, and creative expression among the 0.7-3.2% of young people who identify as transgender and genderexpansive (TGE). mHealth interventions intended for TGE users are situated within-and, increasingly, informed bythis rich online milieu. ICTs permit socially isolated users to transcend the limitations of their physical environments, in which TGE social bonds, gender-affirming
more » ... e therapy (GAHT) providers, or physical safety, may be lacking. This is particularly true of TGE youth, who may lack autonomy or in-person support (1). A diverse, innovative range of ICT interventions serves the genderaffirmation needs of TGE users. As noted by Skeen et al. (1), these interventions can be classified along distinct lineages: (I) academic medicine, often via NIH-funded clinical trials; (II) human-computer interaction, user experience (UX) design, and adjacent subfields; and (III) TGE-led community technologies, often developed via hackathons and crowdfunding. Since the initial, July 2020, publication of that scoping review (1), upheavals have occurred within TGE mHealth, with implications for mHealth self-sustainability, broadly. Most can be traced to the COVID pandemic, which disproportionately burdened marginalized subpopulations. Jarrett et al. surveyed transgender and nonbinary respondents across 76 countries from April-August 2020, 55% of whom reported diminished access to gender-affirming care due to the pandemic; 38% were less able or unable to live in accord with their genders at all (2). In the U.S., the Centers for Disease Control and Prevention recommended the suspension of in-person appointments. Federal regulations that had restricted reimbursement for telehealth services and barred cross-state practice were relaxed (3,4). These changes vastly expanded access to telemedicine, permitting TGE young people to access primary care, counseling, and GAHT initiation virtually, or via hybrid models of care, typically extensions of established providers (3,4). Presently, telehealth cannot replace key aspects of in-person (particularly presurgical) consultation (3), which most TGE youth prefer for GAHT initiation (4). And an "either/or" approach to such questions overlooks the possibility of telehealth-supported specialist consultations and similar hybrid models (4). Emerging evidence shows promise in the acceptability, usability, patient satisfaction, and cost-effectiveness of gender-affirming telehealth, particularly among TGE youth who feel unsupported by their parents (3, 4) . Where TGE eHealth in the COVID era departs most radically from the past is in its abrupt, recent, turn toward venture capital (VC)-backed commercialization. Exemplifying this turn are the telehealth services Folx and Plume. Forgoing any brick-and-mortar presence, both offer GAHT initiation, maintenance (4), and wraparound care tailored for sexually and gender-diverse patients, Letter to the Editor
doi:10.21037/mhealth-22-10 pmid:35928508 pmcid:PMC9344201 fatcat:qe3xf6estvbthe74dkwv7spfse