Open Access

ARTICLE

The cost and guideline adherence of direct-to-consumer telemedicine companies offering gender-affirming hormone therapy

Nicholas Sellke^1,2,*, Erin Jesse^1,2, Justin M. Dubin³, Tomislav D. Medved^1,2, Neha S. Basti⁴, Janvi Ramchandra², Robert E. Brannigan⁴, Joshua A. Halpern⁴, Nannan Thirumavalavan^1,2

1 Urology Institute, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
2 Case Western Reserve University, Cleveland, OH 44106, USA
3 Department of Urology, Memorial Healthcare System, Hollywood, FL 33021, USA
4 Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA

* Corresponding Author: Nicholas Sellke. Email:

Canadian Journal of Urology 2025, 32(2), 89-94. https://doi.org/10.32604/cju.2025.065004

Received 08 August 2024; Accepted 03 March 2025; Issue published 30 April 2025

Abstract

Introduction: Direct-to-consumer (DTC) telemedicine has emerged as an option for transgender patients seeking gender affirming hormone therapy (GAHT). We aimed to characterize the healthcare services provided by DTC telemedicine companies offering GAHT and to compare their costs to a tertiary care center. Methods: We identified DTC telemedicine platforms offering GAHT via internet searches and extracted information from their websites related to evaluation, treatment, monitoring, and cost. Cost of the DTC GAHT was compared to cost for comparable services at a tertiary care center. Results: Six DTC companies were identified. All platforms utilized an informed consent model without prerequisite mental health evaluation for GAHT. Platforms did not provide comprehensive mental health services. All platforms endorsed the use of regular follow up visits throughout the treatment period although interval of laboratory assessment varied. Cost estimates were comparable for uninsured patients and higher compared to those for insured patients. Cost estimates were lowest with private and public insurance at the tertiary center. Conclusions: DTC telemedicine platforms offering GAHT appear to be in line with the recently released World Professional Association for Transgender Health standards of care regarding the laboratory evaluation and monitoring, but it is unclear whether they are compliant with other recommendations. These platforms offer competitive costs for TGD patients without insurance.

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