Telehealth vs. In-Person HRT for Gender-Affirming Care
One of the most comprehensive systemic reviews on gender affirming care to date showed gender-affirming care improves quality of life, stigma, and mental health [7]. So you see, what matters most here is getting medical care if you need it. And it can’t be understated that telehealth helped expand gender-affirming care in meaningful ways. Per WPATH SOC8, "Efforts to decentralize gender-affirming care within primary care settings and establish telehealth services [are being pioneered] to reduce barriers and improve access." [4]
In my personal opinion, both telehealth and in-person options are needed – and kind of like when something goes wrong with your car, sometimes video-ing in, just isn’t enough. While many parts of gender-affirming hormone therapy (HRT or GAHT) management aren’t very complicated and don’t require an in-person evaluation, having the option for both visit types adds to the care provided.
In-person visits can add a beat to the healthcare experience – an intentionality to taking up space; whether that is having the space to emotionally tap in to your HRT experience with an experienced healthcare provider, building on the clinical relationship so that you can be better heard/seen/understood during an appointment, or accessing another point of screening for chronic illnesses like high blood pressure. And at AHM, it also means being part of a different form of HRT care – direct care that doesn’t rely on 15 minute appointments and insurance-directed medicine.
What Is Gender-Affirming Hormone Therapy?
HRT vs. GAHT — same thing, different language
A quick note on acronyms: HRT and GAHT are often interchanged online and while talking. In my clinical notes, however I tend to use GAHT (gender-affirming hormone therapy) as it can be more specific to transitioning.
HRT (hormone replacement therapy)is used clinically for both transgender people (GAHT: when hormones are used to induce secondary sex characteristics) as well as for cisgender people.
Sometimes when HRT is meant to be more specific to cisgender patients, people may use the term “bioidentical” hormone therapy; examples include taking hormones around the time of menopause to help with symptoms or replacing low levels of testosterone to help with low libido or energy. And one could totally argue that ALL of these uses are “gender” affirming – but there are different expected outcomes and different durations of therapy. Different letters, but only sometimes the same meaning.
What your provider is actually doing at each visit
I’m there primarily to help explain what medication effects are expected, to what degree effects are known or unknown, to ensure safety in the prescription and monitoring of the hormone medications, and to provide advice as a medical consult when there are questions about how these hormonal medication affect current, future, and co-morbid health.
For prescription management, I’m there to help with finding the best dose for you. People vary when it comes to how our bodies metabolize and utilize meds, proteins, nutrition, so sometimes an individualized approach can make all the difference.
Additionally, I’m there to help find the best route of administration. Some people prefer the flexibility of a pill, some people want the convenience of a weekly shot. Let’s explore these questions to find out what works best for your gender-affirming hormone therapy.
When it comes to monitoring, this is where telehealth and in-person care benefits can start to differ. Let’s talk about some of the benefits of telehealth first.
The Real Benefits of Telehealth for HRT
Access — especially if you're not in LA
First and foremost – finding a provider who is a good fit for you can be challenging. Telehealth options have expanded accessibility; and I know for myself, when the drive needed to get to where I’m going starts to go over the 45 minute mark, then I’m starting to find other options so I don’t have to do that.
And in LA, those distances are a lot smaller than those in KY where I’m from. If I’m out in Oxnard, I probably don’t want to drive into West Hollywood for a 15 minute check in (although maybe if I get an Erewhon smoothie as a treat to myself afterward, it might be…)
Privacy and the waiting room problem
It’s real. Waiting in the seat where someone is going to call out your name. Asking yourself, “Will they call my legal name or preferred name?” “Will they use gendered language before I even enter the room?” This, while sitting beside strangers in a small public place. Most offices don’t have waiting room privacy, because those are public, multi-use spaces. That’s normal. The situation can cause real anxiety, but is almost expected for many clinic spaces. “Normal.”
However, telehealth avoids that completely. At the time of your appointment, you can sit comfortably in a chair at home (or even at work on break - but PLEASE don’t drive and telehealth at the same time). With telehealth, the waiting room is where you want it to be, so you have more control over the environment with which the medical appointment is taking place.
Flexibility for people with complicated schedules or lives
I know it’s necessary for those in between times when a doctor’s appointment just doesn’t fit into your schedule. That’s why AHM also offers telehealth appointments.
For when you have to see your doc during your lunch break, or when the travel time is too long and too far, video visits come in clutch. Also, if you got your labs done and I have the results, then saving your travel time we can talk numbers and make decisions together without the need to be in the same room.
What the research actually shows
Researchers from FOLX Health and Brown University followed adults who initiated GAHT through a telehealth clinic and found significant reductions in depression, anxiety, and suicidal ideation after 3 months of HRT. [3] The number of people able to access and start hormone therapy would be lower if online telehealth options like FOLX Health didn’t exist. That’s worth some appreciation.
However, HRT care deserves a balanced approach, with both telehealth and in-person options helping to optimize the care given. Overall, people have high satisfaction with telehealth. [2] However, one study explicitly found that patients rated telehealth worse for starting hormone therapy, learning injection technique, and preparing for surgery. [2] Some appointment types can be telehealth, but some maybe shouldn’t be.
What the research shows
Gender-affirming HRT by the numbers
Patient satisfaction with telehealth gender-affirming care
A majority of patients and caregivers rated telehealth visits the same or better than in-person across convenience, privacy, and provider communication.
Apple et al., Transgend Health, 2022 [2]
Time to meaningful mental health improvement
Significant reductions in depression, anxiety, and suicidal ideation seen in adults after just 3 months of telehealth-initiated GAHT.
Corman et al., J Med Internet Res, 2025 [3]
Patients who preferred telehealth for starting HRT
In a study of patients beginning hormone therapy for the first time, none rated telehealth as equal to or better than in-person for that first visit.
Apple et al., Transgend Health, 2022 [2]
Injection teaching: outcomes equivalent
Telehealth and in-person instruction produced equivalent testosterone levels at 3 and 6 months — but telehealth patients needed slightly more follow-up support afterward.
Nightingale et al., Transgend Health, 2025 [1]
Studies supporting gender-affirming care
A landmark systematic review found no studies identifying significant negative outcomes or harms from gender-affirming care.
Johansson et al., eClinicalMedicine, 2025 [7]
[1] Nightingale KJ et al. Transgend Health. 2025;10(4):325-333. [2] Apple DE et al. Transgend Health. 2022;7(2):159-164. [3] Corman JD et al. J Med Internet Res. 2025;27:e64017. [7] Johansson T et al. eClinicalMedicine. 2025. doi:10.1016/j.eclinm.2025.103390
What Telehealth Can't Fully Replace
Starting hormones for the first time
I may be more specific in this, so not sure how generalizable it is… but I started work as a primary care physician who also offered HRT management. I was part of a large academic institution at UCLA Health, so I was funneled patients who sought out the university and then got me due to location or availability. But the longer I practiced medicine, the more I appreciated the relational aspect of care.
I like getting to know the people I’m working with so that I can better understand their goals – and then ultimately if I have a better understanding of their goals, then I can better help them achieve those goals.
I’m not talking about being friends with my patients – I’m talking about making someone comfortable enough to tell me the personal details that matter for their health. For instance, talking about erectile dysfunction as a trans woman isn’t always a comfortable discussion. And knowing the person you are discussing a sensitive matter with – knowing that person is going to respect you, maybe calm your fears – is a professional relationship worth having when going through an experience as sensitive as a puberty.
Learning injections
I’ve done both – I’ve taught injection administration both in-person and virtually. And I can tell you that in my experience, in-person is a better option for most people. In the same room, I’m able to demonstrate and then visualize patient technique better than from a single 2-dimensional perspective on a screen. Research helps back this up, showing some patients report injection teaching was better in-person vs telehealth. [2]
I would also like to mention one study that showed telehealth injection teaching was clinically equivalent to in-person. So the quality of the learning material may be similar. However, notably, the telehealth group had slightly more post-instruction follow-up contacts, suggesting patients needed more support after virtual instruction. [1]
Anything involving a physical exam
Physical exams are limited to self-reporting and what I can see with telehealth. Ya see, I can’t use my stethoscope to listen to your heart and lungs over a screen, I can’t use my BP cuff. If we want baseline vitals, or if you need a pre-op visit 30 days prior to a procedure – it will have to be done in-person.
Additionally, an in-person appointment is an opportunity to screen for other chronic health conditions such as hypertension by getting an accurate blood pressure reading. It allows the space to feel for nodules underneath the skin and assess when that needs further exploration. It means being able to show me an injection site rash or a lump or bump or change in hair or skin and I will be able to better assess what is going on because of the physical exam.
Why I Offer Both — and Why That Matters for Your Care
When creating AHM, I wanted to build a practice that is sustainable, practical, and accessible. This meant threading the needle between a few different concepts: affordability, accessibility, credibility… to name a few.
So for me this was not a question of virtual vs in-person gender-affirming hormone therapy management, but instead a hybrid of both. While telehealth remains an option, particularly for those quick check-ins or for logistical ease, in-person visits are not only available but sometimes recommended.
That first visit is in-person to help establish a clinical rapport and professional relationship. Injection teaching (as needed) is in-person so I can easily guide and help optimize technique on the first go. Pre-op visits are in-person to get all of the information including a physical exam for surgical preparation.
This isn’t just how I prefer to practice. The data backs it up [1,2,5,6]. With the hybrid model being ideal, that’s the direction AHM went and that’s the care I currently provide. If you want to explore more about gender-affirming hormone therapy care and process at AHM, you can visit GAHT Care & Process.
The AHM model
Why hybrid care works
In-person when it matters. Virtual when it makes sense.
The hybrid model isn't a compromise — it's the point
Some visits are better virtual. Some need a room. Having both means your care isn't limited by the format.
How to Choose What's Right for You
-
Here’s what I’d want to know if I were walking into a new clinic:
What does follow up look like? How can I contact you in between visits? What kind of support do you have if I need to be seen in-person?
These questions can help you figure out what kind of care you want to access.
-
A few things stand out: ease of booking, kind providers, and accessible prescriptions. I’d had patients who temporarily lost insurance, lost access to their provider and needed refills on prescriptions. Telehealth-only practices can fill this need by allowing remote access to a provider so that your prescriptions are not interrupted.
-
Certain visit types tend to be better in-person: starting HRT, injection teaching, and pre-op examinations. Additionally, if you have something that cannot be described over a screen (such as a lump underneath the skin), that would be better assessed in person with a physical exam.
-
Physicians are licensed through individual states, meaning I can only practice medicine in the state of California. This means that my telehealth services are only available when someone is physically located in the state of California (although it’s a big state, so plenty of room for virtual visits).
Frequently Asked Questions
-
When it comes to maintenance of HRT prescriptions, yes. However, certain visit types may be better in-person. The visit types that benefit from in-person visits are initial visits to start HRT, injection teaching, and pre-op visits. Otherwise, telehealth HRT is as clinically effective as in-person.
-
Yes, there are multiple platforms that offer HRT prescriptions online. Some of those platforms include Folx Health, Plume, and QueerDoc. At AHM, we send your prescription electronically to your pharmacy, this can be done during in-person or telehealth visits.
-
This depends on the practice – for many, such as with AHM, they are cash only practices that do not accept insurance. Others may accept insurance. Please check with the individual practices to learn more about their invoicing.
-
Unless your provider has medical licenses in multiple states, then you will likely need to find a new provider. There is some leeway around transition of care, but usually you will need to find a provider in the state you are currently residing for continuity of care. Speaking with your current provider before you move can help make the move easier by planning for contingencies.
-
At AHM, absolutely! We can decide together which appointment type would be most useful for each appointment. While in-person will be recommended for some visits like a pre-op visit, others should absolutely be telehealth for convenience and ease.
Sources:
[1] Nightingale KJ, Jelinek SK, Jones C, et al. Telehealth versus in-person injection instruction for adolescents and young adults initiating gender-affirming testosterone therapy. Transgend Health. 2025;10(4):325-333. doi:10.1089/trgh.2024.0130
[2] Apple DE, Lett E, Wood S, et al. Acceptability of telehealth for gender-affirming care in transgender and gender diverse youth and their caregivers. Transgend Health. 2022;7(2):159-164. doi:10.1089/trgh.2020.0166
[3] Corman JD, Hughto JMW, Shireman TI, Baker K, Steinle K, Forcier M. Mental health changes in US transgender adults beginning hormone therapy via telehealth: longitudinal cohort study. J Med Internet Res. 2025;27:e64017. doi:10.2196/64017
[4] Coleman E, Radix AE, Bouman WP, et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022;23(suppl 1):S1-S259. doi:10.1080/26895269.2022.2100644
[5] Dowshen N, Lett E. Telehealth for gender-affirming care: challenges and opportunities. Transgend Health. 2022;7(2):111-112. doi:10.1089/trgh.2021.0206
[6] Sequeira GM, Kahn NF, Stewart MK, et al. Outcomes research on telemedicine-delivered gender-affirming health care for transgender youth is needed now: a call to action. Transgend Health. 2023;8(1). doi:10.1089/trgh.2022.0104
[7] Johansson T, Vinther Larsen C, Zewdu S, et al. Provision of gender-affirming care for trans and gender-diverse adults: a systematic review. eClinicalMedicine (Lancet). 2025. doi:10.1016/j.eclinm.2025.103390
