Denver-based startup Plume uses telehealth to help transgender patients access gender-affirming hormone therapy. Photo credit: Plume

Two friends that met in medical school saw an opportunity improve access to care for the transgender community using telehealth. Dr. Matthew Wetschler and Dr. Jerrica Kirkley founded Plume in 2019. The Denver-based direct-to-consumer health startup provides access to gender-affirming hormone therapy through video visits.

Wetschler had moved to the Bay Area to finish his residency at Stanford, where he started working with digital health startups. Kirkley, meanwhile, was in Colorado, where she built out a gender-affirming care program for a community health center and helped start a free clinic for transgender patients.

They started Plume with the idea of bringing together these experiences into one platform.

“It just seemed like a perfect fit. We were two doctors and a dream,” Wetschler said. “We put together our own money and started a small trial clinic in Denver. The response was robust and immediate. We realized this was something that was desperately needed.”

In its first year, Plume has expanded to 16 states and is onboarding as many as 50 patients per month. With that, Plume is looking for more ways to improve access to care — including partnering with employers to offer its services as a benefit.

The Trevor Project, a nonprofit that offers mental health services for LGBTQ youth, will be one of the first to offer Plume as a covered benefit. In addition, Plume has been in conversations with technology companies who see an opportunity to offer better care for their employees.

Investors have also gotten behind the idea, with backers General Catalyst and Slow Ventures pouring seed funding into the startup.

“I think there is this inherent benefit to employers — individuals that live their full and authentic life bring their best to the table,” Soltan Bryce, Plume’s head of growth, said in a phone interview.

Per the Affordable Care Act, health plans are required to cover gender-affirming care. But in practice, patients’ ability to access care can vary widely, depending on their insurance. Some health plans or physicians require a letter of support from a mental health provider before they will cover hormone therapy as a benefit.

“There are gates in the process that can delay or totally block the coverage of care,” he said. “For trans folks, the quality of care can be incredibly variant if they do receive care at all.”

For some patients, the experience can be so negative that they delay care altogether.

According to the 2015 U.S. Transgender Survey, 23% of respondents said they did not see a doctor when they needed to for fear of being mistreated as a transgender person. For those who had seen a healthcare provider in the last year, one-third said they had at least one negative experience. Many people also reported insurance problems; one-quarter of those who had recently sought coverage for hormones were denied.

The cost of hormone therapy can also vary widely — anywhere from $2,000 to $4,500 per year, Wetschler said. For patients with high-deductible plans, the costs can add up quickly.

“The experience of using legacy health care resources is scary. It’s frightening and sometimes it can be traumatic,” he said. “People are opting to use our service rather than their insurance.”

Currently, most patients who access Plume do so outside of their insurance. More than half of them have insurance products that they choose not to use, Wetschler said.

They pay a $99 monthly membership fee, which covers the cost of appointments and lab work. After an initial video consultation, a care plan is created. Patients can pick up their prescriptions at their local pharmacy, though they still have to pay for medication in cash or using their insurance.

Importantly, Plume’s users also have ongoing access to their care team, many of whom are transgender themselves and understand the experience as a patient.

“Gender-affirming care and hormone therapy at its best unlocks this life of possibility for an individual,” Bryce said. “It can be life changing.”