How Plume Powers Fully Virtual Gender-Affirming Care Through Spruce

Plume is the first healthtech company dedicated to the transgender community. Founded by Dr. Jerrica Kirkley (she/her) and Dr. Matthew Wetschler (he/him), Plume provides safe, convenient, and expert care from the accessibility of a smartphone and uses Spruce to power its innovative virtual platform. The Plume team is seeking to revolutionize the accessibility and delivery of gender-affirming medical care, and their forward-thinking use of the Spruce feature set is a great model for how we at Spruce are also thinking about the future of medicine.

We interviewed Dr. Jerrica to learn more about Plume, telemedicine, gender-affirming care, and how Plume makes use of Spruce.

How would you describe both Plume and gender-affirming care?

Plume is a virtual medical service that delivers gender-affirming care, or hormone replacement therapy (HRT), to the trans community. We’re physically based in Denver, Colorado, but we also take care of patients in California, Florida, Maine, Massachusetts, New York, North Carolina, Oregon, Texas, and Virginia — this makes our service available to nearly half of the trans community — and we’re expanding rapidly.

Gender-affirming care is, at its core, exactly what it sounds like – healthcare that affirms you to live authentically in your gender. More explicitly, this means a departure from the outdated “one size fits all” framework of a doctor dictating the same set of hormones and surgery for every trans person seeking medical care. Instead, gender-affirming care provides each person to seek only those interventions they desire to affirm their own gender identity. In practice, this means that your healthcare provider works with you on your own, unique gender journey, and helps to facilitate any medical interventions necessary for your transition. Additionally, gender-affirming care recognizes that, while there are many medical interventions that some folks need to affirm their gender, other folks may not desire or pursue these types of treatments.

Our model at Plume offers a monthly subscription for direct access to our medical providers for initial consultation, lab monitoring, and prescriptions. Instead of having to schedule an appointment every time you have a question or need a refill, you can just text your care team. We are building a medical service that can move beyond the bounds of brick-and-mortar care and connect patients and medical providers from all over the country. We want to eliminate barriers around accessing gender-affirming care.

How do you eliminate the barriers around access to gender-affirming care?

Currently there are three primary settings where patients access HRT. At best, if you happen to be in a large metropolitan area, you might have access to a LGBTQ+ Community Health Center where you can find competent medical providers in a relatively safe space, but the waitlists can be up to six months long. General primary care clinics are more accessible, but it is incredibly hard to find a clinic that accepts your insurance and is welcoming to trans folks and willing and able to provide gender-affirming care. Oftentimes patients are repeatedly misgendered or called the wrong name.

The architecture around a brick-and-mortar system also still relies on other barriers, like insurance billing, which make it hard to find the right fit. Up to a third of trans folks obtain their HRT from the black market in urban settings, due to lack of access to traditional medical systems. Having a virtual option not aligned with employment, health insurance, or a singular geographic location greatly increases access.

Tell us more about the role of telehealth in your gender-affirming care.

Because we’re a 100% virtual clinic, patients have control over every contact point with us, which allows folks to be more themselves and to be more comfortable with communicating about their care. In the past year with Plume, I have seen patients share more and be more vulnerable than I have in my previous seven years of practice in brick-and-mortar settings. Because we can meet patients where they are, in a place of safety and comfort, whether it is texting or a video visit, I have found the communication to be more genuine and enhancing to the provider-patient relationship. 

What makes your team special?

We are a company that is built by trans people, so the majority of our team is trans, from clinical to product development to marketing to our advisors. Recognizing that the trans community is very diverse, we have a deep understanding of the trans experience and make sure that our internal composition reflects that of the community we are serving. We offer care that is affirming, supportive, and celebratory.

When it comes to cost, we try to be as transparent as possible. We offer a set monthly fee and send prescriptions to your local pharmacy. Medications are not currently included in the monthly fee, but we will be offering mail-order medications at a competitive cash price soon, regardless of insurance or lack thereof. 

Why Spruce? 

We found Spruce when we were researching telemedicine solutions, as Matthew was friends with, and previously trained alongside, Spruce’s chief medical officer, Dr. David Craig. Matthew had worked with some direct-to-consumer telehealth companies in the past and was impressed by both the provider and patient experience. We saw that Spruce was a way for us to have patient-friendly access and deliver the experience that we wanted to.

When a patient joins Plume, they click a link on our website that takes them directly to Spruce. We want Spruce to be their first point of communication with us since we’re discussing sensitive health information; we want everything to be secure. Plus, there’s no pressure on our patients, because the pretreatment communication is free, so we can have a dialogue and see if it actually makes sense for them to become a member.

Spruce has been pretty revolutionary when it comes to medical care. We’ve been able to leverage technology to interact with people on a level that we don’t always see in the clinic. For example, sometimes it’s anxiety-provoking to speak with someone in person, versus just texting them. 

We also use Spruce for internal communication. It’s great to be able to organize our practice in a straightforward way. We have two care coordinators and a growing medical provider base, and we use the paging system often in Spruce.

What are Plume’s Favorite Spruce Features?

• Scheduled Messages: “Scheduled messages are awesome. It’s great to be able to actually schedule a message to yourself, or a patient, in the future.”
• Saved Messages: “The saved message templates are really easy to use.”
• Video Calls: “We use video calls for our initial onboardings to get to know our patients.”

Spruce can help your practice deliver impactful and delightful care that your patients will love. Learn more.