Coming Home to the Fire: Community, Belonging, and Justice-Centered Telehealth for Transmasculine Aging Adults

Background: Telehealth is increasingly positioned as a solution for healthcare access among older adults; yet for transgender older adults, its application remains undertheorized, inconsistently implemented, and frequently reductive. Structural barriers, including provider incompetence, administrative misgendering, insurance precarity, and the clinical invisibility of aging transmasculine bodies, shape this population's relationship to telehealth in ways that existing frameworks have not adequately addressed. Objective: This study examines the structural conditions shaping transmasculine and gender-nonconforming older adults' engagement with healthcare and telehealth, and centers their visions for transformed, justice-oriented virtual care. Methods: Four semi-structured focus groups (n = 14 transmasculine and gender-nonconforming older adults, ages 40-67) were conducted via Zoom in June 2024 and analyzed using Braun and Clarke's reflexive thematic analysis. The study was designed according to community-based participatory research (CBPR) principles. This study followed the Consolidated Criteria for Reporting Qualitative Research guidelines to ensure methodological transparency in reporting. Results: Analysis yielded five themes: (1) the provider competency crisis; (2) administrative violence and the architecture of misgendering; (3) insurance, politics, and the precarity of access; (4) the aging transmasculine body as uncharted clinical territory; and (5) participants' collective vision for relational, community-centered care. Conclusions: We introduce the Campfire Model of Relational Telehealth, a conceptual framework comprising five empirically derived pillars: gathering, warmth, collective knowledge, safety, and accountability. The model argues that telehealth must move beyond transactional encounters toward a relational ecosystem of care grounded in justice, belonging, and structural transformation. We conclude with a call to action for providers, policymakers, and researchers to dismantle structural barriers and advance telehealth that cultivates dignity, belonging, and equity.