Transgender spectrum adolescents and young adults experience numerous health disparities, including higher rates of HIV, mental health concerns, and substance use than youth who are not transgender (Johns et al., 2019). Many experience barriers to seeking or receiving transgender-inclusive health services (Rider et al., 2018) particularly related to sexual health and HIV prevention (Fisher et al., 2018).
In response to Transgender spectrum youth’s (TGY) health needs, They2Ze is an informational app intended to connect transgender spectrum adolescents and young adults to resources related to gender and sexual health, with a focus on HIV prevention. A secondary goal is to link healthcare providers working with TGY, or those who hope to make their practice more transgender-inclusive, to resources (e.g., terminology, best practices, and tips on creating welcoming environments for TGY).
Though not required to use the app, users can create a login, which can allow them to save their favorite resources. The app home page clearly states its purpose and intended audiences. A menu points users to a longer list of the app’s features — for example, links to articles, videos, and support for TGY, information about PrEP (an HIV prevention medication; Centers for Disease Control and Prevention, 2019), and resources for healthcare providers, among others. Clicking on these menu items most often takes the user to a curated list of videos, articles, or links from sources external to the app.
They2Ze offers several in-app tools (e.g., a PrEP assessment form and medication reminders, GPS-enabled resource locator), but it largely serves as a hub for external content. A toolbar pinned to the bottom of the screen has easy-access buttons for a resource locator, emergency contacts, and users’ favorites. Although the resource locator in They2Ze is California-focused, many other features and information in this application are not location-specific and can benefit TGY and providers living elsewhere.
As They2Ze is informational in nature, the length of time one uses the app could vary widely and may depend on the user’s goal. If using the app to look up and learn about a specific resource, a user might spend about 3-5 minutes on the app, whereas users interested in learning about a certain topic or watching videos could easily spend longer than that.
Recommendations for Use
This app is geared toward TGY interested in seeking gender-affirming health information, health services, and resources, as well as clinicians who work with or plan to work with TGY youth. That said, other audiences could certainly benefit from this app, such as allies or family members of TGY wanting to learn more about transgender health, or ways to support TGY they know. Although the resource locator tool focuses on California-based organizations, much of the information in They2Ze is useful for folks located elsewhere.
They2Ze is clearly intended for TGY youth and healthcare providers, and what the app hopes to accomplish, who it’s for, and why are evident on both the homepage and the “About They2Ze” page. The links to health information in They2Ze are of high quality, reflecting respected scientific and medical organizations in LGBT health, transgender health, and HIV prevention.
As the field of transgender health is rapidly growing, the state of the science quickly changes. To that end, the app’s reliance on external links is beneficial in that many sites from major organizations likely will update information frequently. However, reliance on links that took the user to sites outside the app, rather than information contained within the app, is also a drawback. Some of these external links did not work, and other external links may direct users to more general information. Content not specific to healthcare, such as videos and websites of transgender and nonbinary people’s lived experiences, was a nice addition to the application that made it more engaging. Overall, I found the resources provided in They2Ze to be comprehensive, but sometimes they required more effort on my part to digest (for example, some links led me to external resources that were comprehensive, but I had to do some digging to find what I needed.)
The content and resources in They2Ze appear to be geared toward older adolescents and young adults who may already have some experience navigating the healthcare system. Although They2Ze could be informative for younger adolescents, the app lacks guidance on topics such as what questions to ask a healthcare provider, or what documents to bring to an appointment, which younger teens may need to access clinics on the resource list successfully.
Ease of Use and User Experience
I tested They2Ze on an iPhone 7 and an iPad Pro and although it was functional on the iPad, the app functioned better on my iPhone. Although They2Ze is not particularly difficult to learn, navigate, or use, there are certain aspects about its functionality that may be unexpected or frustrating to some users. For instance, when I tried to use certain features, such as viewing recent articles on transgender health, there was no option that allowed me to navigate away from the page, and I had to exit the app to use other features. The search function in the menu bar only searches through the resource list, rather than through any content on the application relevant to your search term, which was not explicitly stated.
Using the resource locator tool may seem somewhat frustrating, as it is not particularly evident that this feature is limited to resources in California; when attempting to search for resources near me in Illinois, nothing came up. Because the application uses a phone’s location for the resource locator tool, rather than relying on the user to input a ZIP code, users may not be able to search easily for resources in locations different from their own.
Finally, it is unclear how often the content in the app is updated. I noticed that an article was posted as recently as June 2019, but links to several external resources were dead. When I tested out the built-in PrEP assessment tool, I marked my age as under 18, and the tool indicated that no guidelines exist for adolescent PrEP use (even though these have been in place since May 2018). When I tested the PrEP medication reminder tool, I received a text stating I was enrolled in the program, but never received any reminders. Users should keep these limitations in mind when navigating through They2Ze.
Visual Design and User Interface
The app has a pleasing, modern, and inviting aesthetic, with a muted green and orange palette. The cartoon imagery is playful and reflects diverse races and genders, and the design is youth-appropriate. For youth who may not be out to others about their sexual orientation or gender identity, or who simply desire a more discreet app, the relative absence of overtly LGBT-oriented imagery such as a transgender pride or rainbow flag may be appealing. The text is easy to read, but as the app does not support larger text sizes, the text may be smaller than desired for users with visual impairments.
The app is generally well-organized, and the menus and toolbar are straightforward. That said, outside of the resource locator tool, when the app provides links to websites, it is not always evident whether the link is specific to California or applicable to the whole country. Users may have to click through to the website to determine its relevance for them.
Overall, They2Ze is a useful informational app for transgender spectrum youth interested in services and resources that are inclusive and vetted by members of their own community. Healthcare providers interested in learning more about available resources for TSY in California and nationwide, as well as learning more about making their practice more transgender-affirming, would also find this useful. As a clinical psychologist and LGBT youth health researcher, I liked using the app and even found several new resources I was unaware of previously. As such, the app’s content and features align relatively well with its stated goals. Given that there are few apps that cater specifically to TSY, who experience major health disparities, They2Ze is admirable as it provides TSY a relatively easy way to access potentially lifesaving information and resources. However, certain aspects of They2Ze’s functionality were not ideal and users may find these things frustrating. More frequent updating of the app, its resources, and tools would make it more user-friendly.
Centers for Disease Control and Prevention. Pre-exposure Prophylaxis (PrEP). 2019. Available at https://www.cdc.gov/hiv/risk/prep/index.html
Fisher CB, Fried AL, Desmond M, Macapagal K, Mustanski B. Perceived Barriers to HIV Prevention Services for Transgender Youth. LGBT Health. 2018;5(6):350–358. doi:10.1089/lgbt.2017.0098
Johns MM, Lowry R, Andrzejewski J, et al. Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students — 19 States and Large Urban School Districts, 2017. MMWR Morb Mortal Wkly Rep 2019;68:67–71. DOI: http://dx.doi.org/10.15585/mmwr.mm6803a3
Rider GN, McMorris BJ, Gower, AL, et al. Health and Care Utilization of Transgender and Gender Nonconforming Youth: A Population-Based Study. Pediatrics 2018;141:e20171683. DOI: 10.1542/peds.2017-1683