Protecting doctors, not patients

MARY REICHARD, HOST: It’s Thursday the 18th of April, 2024. This is WORLD Radio and we’re glad you’re along with us today. Good morning, I’m Mary Reichard.

MYRNA BROWN, HOST: And I’m Myrna Brown. First up on The World and Everything in It: Telehealth and hormones.

A quick word to parents: this story deals with issues related to gender confusion, so you might want to listen before sharing with your children.

REICHARD: Twenty-three states currently protect children from accessing puberty blockers and so-called “cross-sex” hormones. That means 27 other states don’t. So a child who lives in a state that restricts use of those measures could travel to a state that allows them.

But what about telehealth medicine? Doctors can offer consultations online or by phone and then fill prescriptions that patients can have mailed to their door. Is it possible for children to get life-altering hormones in this way?

BROWN: WORLD’s Juliana Chan Erikson investigated the question and brings us the story.

FOLX HEALTH AD: Are you struggling to find hormone replacement therapy and don’t know where to look? Folx Health has your back.

JULIANA CHAN ERIKSON: Folx Health is one of a growing number of telehealth services that cater to people identifying as LGBTQ. And right now it can serve all 50 states because it omits a big segment of the population—children and teenagers.

As states and courts go back and forth over whether children should have access to cross-sex hormones, many providers are doing their best to stay legal and out of political hot water.

But telehealth is a relatively new industry, one with evolving rules, infrastructure and patients willing to test its limits.

EMELIE SCHMIDT: I want to start off by saying I did not use the transgender telehealth when I identified as trans.

That’s Emelie Schmidt. When she was in high school, she identified as a male and immersed herself in online forums where other users celebrated transgenderism. Somebody from the forum sent her a chest binder, and at school, teachers spoke to her using male pronouns. But by the end of high school, she realized it was just a phase and she went back to living as a female.

Schmidt never used cross-sex hormones, but she wondered how easy would it be to get them via telehealth? So a few months ago, she checked out Folx Health. The doctor who met with her over video call told Schmidt that she would not need to submit any blood work to receive hormones.

SCHMIDT: February 21, at 1:31 p.m. is when I was trying to get the hormones, when I started. And then February 23, at 2:08 p.m. is when I received testosterone at my doorstep.

That’s right. Just two days after first contacting Folx Health, Schmidt received a package of life-altering hormones. The experience made Schmidt wonder, could a minor do the same?

While most providers in the hormone business require clients to be 18 or older, I did find one, QueerMed, that offers hormone treatments for minors. That said, Dr. Izzy Lowell, a representative from QueerMed, told me in an email, “WE COVER 46 STATES AND WE TREAT MINORS IN ALL STATES WHERE IT IS LEGAL.” But she also admitted that it would theoretically be possible for an adult to order hormones and give them to a child.

While some states have made these treatments illegal, others are trying to make it easier for children to obtain life-altering hormones.

WES MOORE: When I proudly sign the trans health equity act, each and every one of you should feel proud because your fingerprints are going to be all over it.

Last year, Maryland Governor Wes Moore enacted a law that allows the state to use Medicaid to pay for so-called “gender-affirming care.” And earlier this month, Maryland lawmakers passed a bill that would protect doctors who provide transgender treatments to anyone, including children who come from states where it’s prohibited.

Eleven other states already have similar laws in place.

Jonathan Alexandre is a lawyer and legislative counsel for the Maryland Family Institute. He says there’s one other issue where doctors in his state enjoy so much legal protection at the risk of harming patients—and that’s abortion.

JONATHAN ALEXANDRE: If we're following the track of the abortion pill and telehealth, that seems to be the same sort of path that the puberty blockers are going on. So one way to jump the gun and anticipate what the next avenue of fight is when it comes to stopping puberty blocking medication is really just by following a trend of what they've done to the abortion pill.

Still, even if telehealth providers manage to stop underage patients in protected states from getting the hormones, other people I spoke with say using telehealth this way is just not safe, even for adults.

AARON DIPIETRO: It’s not about making it harder or easier. It’s about making sure that people have full informed consent, and they know every aspect of what is going on in these procedures.

Aaron DiPietro is legislative director for Florida Family Policy Council. Last year Florida Gov. Ron DeSantis signed a law that requires adults to meet with a doctor in person and sign informed consent forms before getting hormones.

The forms say the signers are aware of the health risks before they undergo any transgender procedure. DiPietro says this is necessary because it’s likely many patients looking for cross-sex hormones—adults and children alike—are also dealing with something else.

DIPIETRO: Many of these people are dealing with mental health issues, they're dealing with, you know, trauma, they're dealing with psychological issues that need to be dealt with, in a completely different way. You cannot fix psychological issues with just a telehealth, you know, medical prescription.

Emelie Schmidt says she’s thankful she couldn’t access cross-sex hormones in high school, and she hopes telehealth providers raise the bar for medical intervention.

In the end, the treatment that helped Schmidt most didn’t come through a syringe, but a long conversation with her mom during a road trip.

SCHMIDT: So I started coming into reality after my mom took me on a beach trip, January of 2017. My mom was just telling me about how it's okay to be a girl that's not girly. So you're still a girl, even if you aren't girly.

Reporting for WORLD, I’m Juliana Chan Erikson.

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