Gender-Affirming Care Without Walls: Utilization of Telehealth Services by Transgender and Gender Diverse People at a Federally Qualified Health Center.

Purpose: This article characterizes a telehealth program implemented during the COVID-19 pandemic for transgender and gender diverse (TGD) patients at Fenway Health, a federally qualified health center in Boston, Massachusetts, specializing in gender and sexual minority health care. Telehealth is well positioned to meet TGD patients' health needs by allowing them to conveniently and safely engage in care. Methods: The COVID-19 pandemic has presented the opportunity to reimagine the way that Fenway Health provides care, by pivoting almost completely to a virtual model in response to this public health emergency. From March through August 2020, TGD patients (n=3189) from 24 U.S. states utilized our telehealth medical and behavioral health (BH) services. Results: Fenway Health cared for close to as many unique TGD patients during this 6-month period via telehealth as it did via in-person services during calendar year 2019 (3794 medical patients in 2019 vs. 3033 in March through August 2020 [95%]; 946 BH patients in 2019 vs. 911 in March through August 2020 [96%]). TGD patients who utilized telehealth had a similar demographic profile as those who used in-person services. Conclusion: Fenway Health quickly pivoted to telehealth during the COVID-19 pandemic enabling gender-affirming care for TGD communities. By increasing access to clinicians trained in gender-affirming care, telehealth helps ensure that TGD patients regardless of geographic location can access crucial health services. Given the dearth of gender-affirming health care services across the United States, permanently removing state licensure requirements and payment parity for telehealth could ensure access to more gender-responsive care across state lines.

Comprehensive transgender healthcare: the gender affirming clinical and public health model of Fenway Health.

This report describes the evolution of a Boston community health center's multidisciplinary model of transgender healthcare, research, education, and dissemination of best practices. This process began with the development of a community-based approach to care that has been refined over almost 20 years where transgender patients have received tailored services through the Transgender Health Program. The program began as a response to unmet clinical needs and has grown through recognition that our local culturally responsive approach that links clinical care with biobehavioral and health services research, education, training, and advocacy promotes social justice and health equity for transgender people. Fenway Health's holistic public health efforts recognize the key role of gender affirmation in the care and well-being of transgender people worldwide.