QuTe & Healthy

Queer-trans people have long been denied access to safe, affordable and affirmative healthcare services despite being historically and inaccurately pathologized. Many LGBTQIA+ people who experience gender dysphoria (or are exploring gender euphoria) must go through a cumbersome and bureaucratic process to start HRT. Among those who are able to access treatment, many lack access to an informed healthcare provider who can guide them through their journey, taking into consideration co-morbidities, help plan for any expected side-effects, transition milestones, and gender-affirmation surgery if desired/medically advised. Social stigma, disinformation and systemic societal discrimination act as barriers preventing trans people from accessing appropriate care. A study by Kaiser Permanente in 2018 reviewed eight years of medical records of nearly 5,000 transgender patients and over 97,000 cisgender patients with similar age and health characteristics and found that transgender women on hormone therapy were found to be 80 to 90 percent more likely to have stroke or a heart attack than cisgender women. Furthermore, trans people have a significantly lower life expectancy than their non-trans counterparts, one study showed that trans people were more than twice as likely to die over the studied time period. This dearth of dependable resources results in a trial-and-error approach for most individuals seeking medical gender transition. Resources on the internet are often heavily geared towards or based on white people, and do not account for the experiences of brown/desi people. Popular medication and treatments described on the internet may also not be available or affordable in India. 

While the lived experiences of community members is essential and invaluable, it is also inadequate. The science behind the medical transition is fast changing, and safe treatment plans need to be devised subjectively, to an individual's medical history and their social experiences/circumstances.  Even when an individual has access to a queer affirmative healthcare provider, the consultations are often customary, geared towards legality rather than being comprehensive of the individual's needs. 

For queer people, gender transition journeys are especially complex involving multiple components: legal, social, and medical transition. The timelines of these journeys are often not discrete and affect each other in complicated ways. For example, a person suffering gender dysphoria might not be able to fully transition due to not being out as queer socially. Hence, to help mitigate their dysphoria while allowing them to be safe, they might need a customised treatment plan. Despite the complexity of these cases, research around them is sorely lacking. Queer people's medical transition is often dependent on their ability to advocate for themselves and the medical professional’s personal bias/lack of information.

What are the goals for an individual's medical transition? How does their medical transition relate with their legal and social transition journeys? Will medical transition, while urgent to treat gender dysphoria, endanger them socially? What side-effects and pre-existing conditions need to be monitored? These are the questions that need to be continuously asked, tracked and updated but are often completely overlooked or un-communicated.

QuTe & Healthy is an app that allows queer-trans people to track their transitions easily and comprehensively. Our solution addresses these issues in three major ways:

1. Comprehensive tracking of transition journeys

QuTe & Healthy aims to directly address this problem and improve a person’s access to life-saving gender-affirming care by creating a space where a person can comprehensively track their transition journey. The app will offer both quantitative and qualitative documentation of a person’s journey, tracking their vitals, any pre-existing medical conditions, physical changes, emotional changes, and mental state. All input fields will be accessible by voice and in regional languages. Inputs will be automatically transcribed and can be translated to multiple languages to ensure proper communication. 

The platform not only enables both a patient and a healthcare provider to view the transition journey as a holistic experience, but will also underscore the importance of factors (social, legal and medical) that might otherwise be overlooked or dismissed. Users will also have access to glossaries of terms in multiple vernacular languages enabling communication in languages where there are no standardised queer terminologies.

2. Safe and easy communication of information

We envision QuTe & Healthy as not just a personal tracker but also as a tool of self and community care. For many queer-trans people, transition can be an isolating and overwhelming experience. QuTe & Healthy can facilitate the building of community by allowing users to create their own networks with fellow users on the app.Through a 2-step authentication process, verified users can be added to a person’s network, and be designated different roles (health care provider, emergency contact, friend). Each user can also be granted a flexible and specific level of access relevant to the need. This will allow users to share updates and resources and offer solidarity & support to each other in what can often be a long and gruelling process.


3. Self-determination of progress

Often, personal tracking apps (fitness, wellness and menstrual trackers) become ways of reinforcing cis-heteronormative notions of gender and health. Even when apps claim to be inclusive, through design and language, they reinforce stereotypes and ideals that harmfully affect users’ mental states. We aim to actively address this by emphasising self-determination of progress. QuTe & Healthy will help facilitate decision-making towards self-set goals rather than reward or gameify the process in a way that sows comparison/competition.

Our solution aims to serve gender-queer, non-binary, trans people in India. Queer-trans people have been historically marginalised, stigmatised and denied life saving medical care to address gender dysphoria. Queer people in India, unlike other marginalised communities, have to struggle for accessing basic sexual health and social services. Being invisible and hypervisible to the society and the government erodes their sense of personhood, constantly endangers them and impacts their right to health. The Law, social stigma, disinformation, lack of sexual education, and systemic societal discrimination all work together to exclude queer-trans people from participating as equal citizens and adversely affects their physical, mental and sexual health (Stigma and health of Indian LGBT population, 2022).

Our app aims to serve these marginalised communities by creating a tool that documents and creates a comprehensive snapshot of health that helps patients articulate their experiences and needs and urges medical professionals to take a more holistic approach to their treatment plans. 

Specifically, in Hyderabad where our operations are based, we have countless firsthand accounts from trans people who have been harassed when seeking medical treatment. At a government clinic especially established for trans people, patients are routinely subjected to a physical genitalia examination irrespective of their medical complaint. Further, when experiencing any medical ailment, doctors immediately suggest pausing medical transition (a phenomenon commonly called “trans broken arm syndrome”). This comes from an ignorant and lazy assumption that any medical ailment a trans person is experiencing must be caused by their transition treatment. Conversely, when designing the transition treatment, doctors do not take into sufficient consideration pre-existing conditions to customise and monitor a treatment plan that is safe for the patient. 

This cruel catch-22 makes medical transition an arduous and risky process. Further, due to lack of sensitisation of doctors, the burden of educating healthcare professionals about queer-trans people falls onto the patient. Due to a lack of standardised queer vocabulary in regional languages, this can be an especially gruelling process. 

While there is some amount of visibility and  cultural understanding about trans women, for trans-masc people, medical transition can be especially gruelling. As ingesting testosterone can have varied effects on their menstrual cycles, and the timing of surgical procedures like a hysterectomy, if desired, becomes crucial to protect overall health. 

The lack of knowledge among healthcare providers coupled with social stigma makes gender dysphoria a truly dangerous condition that has resulted in countless preventable deaths. QuTe & Healthy aims to serve these groups by creating a tracker and directory of resources including glossaries that can be accessed in multiple languages. 

Since April 2023, our team has been running a physical resource center for queer-trans people called Queer-Trans Wellness & Support Center (QT Center). The first of its kind in the state, QT Center has been offering a wide variety of services in the last year: a free legal aid clinic for LGBTQIA+ people run in conjunction with the government (District Legal Services Authority), a 24/7 helpline, a drop-in space for community events, community building activities like theatre and dance classes, and free mental health resources (twice a week art-based group therapy sessions and 20 hours of free personal therapy each month). Our primary long-term goal is the full realisation of sexual and reproductive health rights for queer-trans people. 

The Center is run by an all queer staff, majority of whom are trans people. As individuals, our team has been part of local LGBTQIA+ rights movements for the last ten years and have deep bonds with the local communities. Through the Center and our own personal relationships with the community, we have a unique understanding of the resources needed by and unmet for the queer communities. 

In the last year, QT Center has become a venue for events organised by and for queer people, including free health camps, medical transition educational workshops, and support groups. Through our helpline, we receive many calls asking for information about medical transition and requesting references to gender-affirmative doctors. We also often receive complaints about malpractice, and engage with government, police and medical professionals to educate and sensitise them.

In the next few months, QT Center is working towards opening a temporary shelter that will accommodate up to 10 adult queer people facing homelessness, at a time.

Our work, while serving the needs of queer-trans people on the ground, also includes the documentation and archiving of queer stories allowing us to understand the kind of resources that are urgently needed, not just to navigate crises, but to prevent crises.

An app that is accessible and inclusive, promotes gender-affirming treatment and empowers queer-trans people to support each other and advocate for themselves with medical professionals would be invaluable. With our ties to the community and our work, we believe we could implement QuTe & Healthy in a way that is community-led and authentic to the needs of queer people.

For the last one year, we have had a functioning 24/7 helpline that serves any query from the queer communities or families of queer people. We have received over 1150 visitors for various activities in the Center. We have handled over 7 distinct health-related legal cases (malpractice and advocacy for treatment). We have conducted a health camp for over 145 individuals. We also have partnered with local community based organisations in organising a two days workshop for trans masc persons about gender-affirming health care and mental health care. We have also been engaging with regional public health institutions and also non-profit hospices to open them up for queer-trans people. In our work at QT Center, we have been building a working relationship with LGBTIQA+ organisations across the country. We believe this growing network will enable us to reach out to the wider community in making this app accessible.  

All of this work has helped us build a foundation: trust with local communities, access to local healthcare providers, and a process of escalation with government and law enforcement officials. We are now in an ideal position to scale specific services using technology. 

With our direct beneficiaries, we would be able to robustly beta test our app, eventually scaling across the country and across South Asia. 

We believe our existing work of community-building, documenting and archiving queer stories, and engaging with and educating government officials and medical institutions will provide a strong ethos with which QuTe & Healthy will be an affirming and safe space.

Through MIT Solve, we hope to make collaborations and partnerships that will help us in the following aspects: 

• Domain Expertise 

We want to collaborate with queer-affirmative researchers, endocrinologists, gynaecologists, urologists, pelvic pain specialists, reconstructive plastic surgeons and other medical experts to ensure the app tracks meaningful parameters and to build a comprehensive directory of information. 

• Monitoring and Evaluation 

To create a space that is both safe and transparent, we wish to collaborate with a third party M&E team that will ensure security of any data stored, privacy and anonymity of any data collected, and veracity of any studies and research done. 

• Technology 

To scale our app, we hope to collaborate with robust technical partners who can handle high volumes of traffic and adhere to the highest standards of data security and privacy. 

Currently, an app like this does not exist. QuTe & Healthy will serve any person, irrespective of gender, who is undergoing a form of medical transition. The app will not only help track vital parameters, but will help build community, and resources in regional languages. 

The few apps that currently track hormonal health are limited to people who menstruate, specifically cis women. These apps too, are often limited in their scope, usually used to track only frequency. It is a common experience among even cis-women that many health conditions like pcos/pcod and menopause are untreated or mistreated. This is because medical research is tilted largely in favour of cis-male white bodies.

QuTe & Healthy, by challenging common assumptions of gender has the potential to contribute to research that will benefit everyone.