Trans patients get help from afar thanks to telemedicine
By Victoria Colliver, November 5, 2016
A young doctor from Delaware with a transgender patient wanted to know how his medications for bipolar disorder would affect his hormone therapy.
The physician, still in a residency program, contacted TransLine, an e-consultation service that operates out of San Francisco’s Lyon-Martin Health Services, which serves women and transgender people.
“I’ve never done this before,” the doctor wrote. “Do you have any advice on whether I’m doing the right thing?”
TransLine, which does not take questions directly from patients and provides only clinician-to-clinician support, has grown from answering an average of three questions a month when it started in 2012 to more than a question a day now. Most of the questions concern hormone therapy, but they also include queries about surgery, insurance coverage, fertility and mental health.
“This is a much-needed service. There really is nothing else like it in the country, or even the world as far as we know,” said Lyon-Martin’s trans health manager, JM Jaffe, who manages TransLine.
TransLine is essentially a form of telemedicine, the growing practice of providing medicine remotely. While some practices involve video or other more sophisticated technology for virtual visits, TransLine is a basic email consultation service that relies on volunteer clinicians to answer questions, typically within 30 hours.
About three years ago, TransLine started adding providers from health centers around the country who have expertise in transgender care so Lyon-Martin staff no longer have to answer all the questions. The clinic has partners in Boston, Philadelphia, Springfield, Mass., and Baltimore, and plans to work with a practice in Chicago. Lyon-Martin became part of the HealthRight 360 group of free clinics last year.
“We have providers all over the country and our vision is to expand it further,” Jaffe said.
Lyon-Martin’s medical director, Dr. Dawn Harbatkin, modeled TransLine after UCSF’s National HIV Telephone Consultation Service, which provides providing readily available expert HIV/AIDS consultation to clinicians nationwide.
“I used the HIV warmline all the time to support my care,” she said. “I figured if I’m a physician in the middle of Iowa and I have a transperson come into my practice ... there should be a place to go” to get questions answered.
Awareness about transgender care is increasing, but it’s not a specialty, nor is there any certification or national standards for care, Harbatkin said. “We starting to see changes in medical school curriculum, in nurse practitioner curriculum that, over time, will see some impact, but it’s slow going,” she said.
As the service has grown in popularity, so has the level of complexity of the questions asked by providers around the country, said Dr. Nick Gorton, a Lyon-Martin physician.
“It used to be ‘I have a trans patient. What do I do?’” Gorton said, adding he used to be able to answer about 90 percent of the questions off the top of his head.
In another recent question submitted to TransLine, a doctor in Oregon asked what needed to be done for a male-to-female patient whose testosterone levels had fallen below normal levels due to hormonal therapy. The volunteer physician chimed in with various suggestions of how to adjust the medications.
Jaffe is not a physician, but often answers questions about insurance and cultural sensitivity.
“Occasionally, we’ll get a provider who is very new to trans care and is not asking questions the right way or is misgendering their patient,” said Jaffe, who finds it rewarding to help. “We want to be very clear how grateful we are they are serving trans patients and that they have found their way to the TransLine and want to do the right thing.”