Associations of Well-Being,Rurality,and Telehealth Delivered Peer Support Among Transgender and Gender-Diverse Patients Receiving Hormone Therapy

Abstract

Purpose:

The purpose of this study was to test associations between rurality, gender-affirming hormone (GAH) use, peer support groups (PSGs), and well-being among transgender and gender-diverse (TGD) adults.

Methods:

TGD adults (N = 1350) self-reported on their well-being (Community Connectedness, Gender Identity Reflection and Rumination, Generalized Anxiety Disorder-7 [Anxiety], Patient Health Questionnaire-9 [Depression], World Health Organization Quality of Life-BREF), locality (which was converted to rurality), amount of time receiving GAHs, and involvement in PSGs, from January to August 2023. Cross-sectionally, we tested the main and interactive effects of rurality, GAH use, and PSGs using linear regression.

Results:

Main effects suggested that TGD adults living in rural areas self-reported more anxiety and less satisfaction with access to health services (ps < 0.05), and individuals who were involved in PSGs self-reported more gender identity reflection/rumination, more meaningfulness of life, but less sexual satisfaction (ps < 0.05). Lastly, individuals undergoing longer GAH self-reported less gender identity reflection/rumination, more body/appearance acceptance, and more satisfaction with self, but less satisfaction with access to health services (ps < 0.05). Interactions suggested that telehealth-based PSGs were disproportionately associated with TGD adults’ quality of life, satisfaction with self, satisfaction with health, and access to health services if they resided in a rural location (ps < 0.05).

Conclusions:

Although preliminary, these results suggest that telehealth behavioral health can bridge care gaps to improve well-being of TGD individuals. Peer-led interventions’ ease and cost-effectiveness at scale—compared with behavioral health services provided by licensed clinicians—could have large implications. Future research should replicate and extend these findings.

Keywords

health care mental health peer support rural transgender well-being

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