Telehealth in the LGBTQ+ Community
Telehealth has been established as a modality to improve access to care, decrease costs and, in many studies, has been able to demonstrate that it has the same quality of care. Within the US, there are a number of populations that have historically been marginalized leading to worse healthcare and outcomes. The question then becomes whether virtual care can aid and improve healthcare for all rather than some.
The LGBTQ+ population is made up of many distinct identities and have specific needs. All of them, however, have historically had more stigma and discrimination in healthcare and medicine, all of which has led to worse outcomes. There are a number of examples. Lesbian and bisexual women have higher rates of breast cancer. Gay and bisexual men are more likely to have HIV/AIDS. Older LGBTQ+ patients rate their health as poor, are likely to have a chronic condition with less social support. Overall, most are less likely to have a primary care provider and health insurance, higher risk of worse mental health, higher risk of substance use, higher risk of dying by suicide and being victims of violence. The transgender community has worse outcomes on almost all of these measures - this is especially compounded if they are of a racial or ethnic minority.
Aside from the physical and mental health risks, LGBTQ+ Americans are more likely than the general population to live in poverty and lack access to adequate medical care, paid medical leave, and basic necessities which was especially noted during the pandemic. It’s also noted that many clinicians lack the cultural competency for counseling and care furthering these disparities and leading to worsening outcomes. Compounding this is the discrimination that faces these populations leading to fear of coming out making health statistics and numbers even harder to fully understand, with the reality that they may even be worse than stated.
Telehealth in the LGBTQ+ population
Like many parts of our healthcare system, the reasons for this are complex and not solvable by one measure. Telehealth won’t be that solution either. Saying that, this is how it is and has helped.
Increased Specialty Access: Some of this specialized care, such as hormone therapy for transgender patients or PrEP (pre-exposure prophylaxis) for HIV prevention. This might be harder to access especially in rural or conservative areas. Patients can find companies that staff and ensure culturally competent care. Telehealth bridges this gap and lets anyone access these services from wherever they are.
Privacy and Confidentiality: I have a number of stories of LGBTQ+ patients who did not want to show up to their local clinic for many reasons. Telehealth felt more private since they could do it from home rather than walking in somewhere.
Support for young or vulnerable LGBTQ+ patients : This is similar to above as there is still stigma and discrimination toward this population. This can be scary and stressful which can’t be overstated. So many patients are waiting longer to get healthcare which leads to worse outcomes. There are now a number of companies specifically aimed at helping this patient population to get care regardless of geography - something possible with telemedicine. I mention some further down.
Mental Health Support: Mental health is still the largest use case in telehealth and can get everyone more access to this type of care regardless of geography. Companies that specifically have trained clinicians to treat the mental health issues that LGBTQ+ population are also popping up.
Continuity of Care: This is useful for all patients who have ongoing care. For those going through hormone therapy and require check-ins, telehealth can avoid travel burden. This can hopefully allow for more people to get this therapy since they won’t have to worry about travel and the associated increased costs.
Reduced Travel and Costs: This helps everyone. Especially if insurance won’t cover certain services (which is a whole other issue of decreased access).
Telehealth can, like for anyone, connect patients to care that might be difficult to receive and with clinicians that are clinically competent.
Here is some other good news. Telehealth and other digital health companies that offer targeted services for distinct groups within the community are popping up more and more. A startup called Plume offers telemedicine for gender-affirming care, ensuring that they are using inclusive language, have input from the community and allow for improving access. Queerly and Violet Health connects patients with culturally competent practitioners, with the latter finding they were able to retain 3x the number of patients. Ash wellness offers secure and private PrEP testing and counseling. Folx Health offers sexual health and hormone replacement therapy and was one of the first venture backed companies in this space.
These examples and companies not only offer virtual care, they ensure that the care received is specific to the needs of the LGTBQ+ population. This can successfully decrease some of their health barriers. Telehealth has made a profound impact on the LGBTQ+ community by breaking down barriers to care, ensuring privacy and confidentiality, and providing much-needed mental health support. By making specialized and affirming healthcare accessible from anywhere, telehealth empowers LGBTQ+ individuals to take control of their health and well-being. As telehealth continues to advance, it promises to further enhance healthcare equity and inclusivity, ensuring that everyone, regardless of their sexual orientation or gender identity, receives the quality care they deserve.
A note to clinicians: to be successful in telehealth, it is imperative to start a session with inclusive language, ensure you have the patient’s preferred pronouns and that the session is private. Understand the barriers faced by this population including lack of safe space, lack of LGBTQ+ friendly healthcare clinics, and not getting screened properly or safely for the specific health scenarios that they may be more prone toward. Improving knowledge can have a bigger impact on our patients and should not be taken lightly. Consider referring patients to specific clinics or providers if needed.
For anyone wanting further resources and information, these organizations are some that work either on healthcare or for the LGBTQ+ community as a whole.
National Coalition for LGBTQ Health
Happy Pride to all!