One of the most widespread and important developments of the last five years has gone largely unrecognized: the rise of telehealth. It has quietly taken the world by storm precisely because it eradicates one of the most frustrating experiences of modern life, the routine medical appointment, at exactly the right moment. With the whole planet functionally grounded, and fear of catching or spreading COVID-19 still acute, telehealth has stepped into the void. So it was only a matter of time before people started identifying new and innovative uses for it.
A dermatologist presents the programme that will be used by doctors for remote diagnosises during … [+]
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Since 2014, when TIME Magazine declared “the trans tipping point,” transgender healthcare has become one of the most hotly debated and controversial subjects in American public discourse, filling the place once occupied by same-sex marriage as a big issue of the culture wars. While increased visibility has certainly had benefits in terms of more widespread acceptance and understanding, it has also amplified the anxiety around pursuing transition healthcare while highlighting how difficult it can be to obtain.
Dr. Jerrica Kirkley, M.D., a practicing physician and trans woman herself, wants to fix that once and for all with telehealth startup Plume. Plume specializes in offering transition care to trans people of all stripes, combining access to educated doctors with the privacy of video chat. But we’re not here just to talk about what she’s building, but how. How do you get funding for a specialized product like this when there remains so much opposition to trans care in principle? How do you make it work?
With questions like that on my mind, I sat down (virtually) with Dr. Kirkley to talk about Plume, entrepreneurialism, funding, and where it goes from here.
Liz Elting: The lack of widespread trans-affirmative and LGBT-focused healthcare, especially outside of major cities, is well documented, so I’m sure this is an idea you’ve had kicking around for a while. What finally prompted you to go for it? In other words, why now?
Dr. Jerrica Kirkley, M.D., Plume Co-Founder and Chief Medical Officer: As both a physician providing gender-affirming care for almost 10 years and as a trans woman myself, I have been intimately acquainted with the challenges in our current healthcare system for trans people for some time. My co-founder Matthew Wetschler is also a physician with a public health degree who had been working with direct to consumer (DTC) telehealth. In 2019 we saw that nobody was doing DTC trans care and it fit the model perfectly coupled with a dire need—well-scoped longitudinal care, backed by guidelines with predictable prescriptions and lab monitoring. We decided to go for it and piloted the idea in August of 2019 with our own money.
Elting: Both women and LGBT entrepreneurs face a notoriously steep climb in seeking funding. How has your experience been?
Kirkley: Seeking funding for a trans-focused healthcare company has not been without its challenges. But we told our story to anybody who would listen and told it from the heart. We found some great mission-driven funds along the way who are looking to support diverse founders and bold ideas that impact marginalized communities. Funds that understand you can do well by doing good. We feel very fortunate to be here and will continue to do everything we can to continually reinvest into our trans community to provide the best care possible to as many people as possible.
We closed on our first round of venture capital funding February of 2020 to start building Plume in earnest with a little over $3 million from General Catalyst, Slow Ventures, and Springbank Collective. We just recently closed on our series A round of $14 million, backed by Craft Ventures, Townhall Ventures, General Catalyst, and Slow Ventures.
Elting: How did you pursue funding? Did you encounter difficulties or resistance?
Kirkley: We sought venture capital funding after a few months of running a small pilot and talking to many friends, patients, and community members, asking as many questions as we could to make sure this was something that was needed and desired by the trans community at large.
I come from a background in grant funding through non-profit community health centers and free clinics. I always thought that was the only way to reach underserved communities, but after spending 10 years constantly trying to cut through red tape and seeing many patients fall through the cracks, especially trans folks, it became clear a new model of care and funding, unburdened by the legacy healthcare system, was necessary to truly meet patients where they are.
The feedback and traction of the pilot made it obvious that this needed to exist in the world, so we sought to bring it to a larger stage. There were certainly challenges along the way. Many people are not truly aware of the trans community, especially our sheer numbers and our needs and how every major institution, especially healthcare, does a poor job meeting those needs. So, it involved a lot of education about the status quo and convincing investors of the power of a relatively small but increasingly visible community and a drastically unmet need.
We stand firm in being 100% devoted to the trans community and to giving our community the resources and care it deserves after being, at best, an afterthought for so long, even in LGBTQ+ settings. It is great to see more companies like Euphoria and Folx getting venture investment to support the trans community, as well. Seeing more investment dedicated to trans-focused services is an exciting moment and milestone, we’re humbled to be the first company of, hopefully, many to serve and address the needs of the community in this way.
Elting: What avenues exist for LGBT entrepreneurs to secure financing for their own businesses?
Kirkley: The opportunities are certainly increasing in the venture capital world. There are an ever-growing number of venture capital funds looking to invest specifically in underserved communities. It depends on the business, but there are other ways as well including, but not limited to, angel investing, loans, nonprofit grants and crowdfunding campaigns.
Elting: Tell us about your vision for scaling up in scope and capacity. In your wildest dreams, what would Plume become, and how do you get there?
Kirkley: Plume has already become one of the most sought after sources for gender-affirming care in the United States, which is a dream come true. We see Plume becoming an internationally renowned center of excellence of gender-affirming care. We will accomplish this by making gender-affirming care services available to every trans person in the US, providing excellent evidence-based care, and holistically supporting the trans journey. We also see Plume as a trailblazer in identity-based care that will prove out a care-delivery model that can be applied to any underrepresented and marginalized community not served well by the legacy healthcare system, thus forging a new paradigm in healthcare, which has long operated in disease-based care with identity as an afterthought.
Elting: Poverty and underemployment are both endemic in the trans community, which makes me wonder about the pricing. $99 a month can be quite a burden. Do you have plans to try and bring the cost down or otherwise make it more financially accessible? If so, how?
Kirkley: We know how financially inaccessible gender-affirming hormone therapy can be for trans people, and we are working to deliver the most affordable care we can whilst sustaining a large national business. On average, folks without health insurance are paying $2,200 to $4,400 a year out of pocket for gender-affirming care. Even with health insurance, some people pay upwards of $1,500 per year. So $99 a month, which includes lab work four times per year and consistent and easy access to expert care, is a more affordable option for many patients.
But for trans people, the costs go far beyond the price of clinic visits, prescriptions, and labs. Access to reliable, secure transportation is a barrier to many. With long wait lists in most brick and mortar settings, delaying care can be detrimental to mental health with depression and suicide rates upwards of 10 times that of the US population. Even just leaving our homes can be a significant safety threat to many trans people.
Still, as we all know, $99 a month is still out of reach for many, and we don’t stop there. We have already created the largest Gender-Affirming Hormone Therapy (GAHT) access fund ever through Point of Pride, with support from YouAreEssential and For the Gworls to fund an entire year of care, including medications, for Black trans folks in its first cycle. We continue to build this fund to be available to all trans people who have limited means to pay for care otherwise. We are also looking for other ways to further increase access to folks with financial limitations. You can find out more at
Elting: What infrastructure challenges have you faced in building Plume? In other words, what are the gaps in providing this kind of service to this underserved population?
Kirkley: Smartphones are seemingly ubiquitous but there are certainly folks who don’t have them or who don’t have reliable connectivity to the internet, both of which are necessary to engage in care through Plume. While having access to a smartphone and internet is more likely than having reliable transportation for many, we do recognize this as a limitation for some. There are many regulatory requirements for telehealth that can limit the rate of expansion, which we are constantly working on to bring access to all 50 states.
Providing low-cost lab testing as part of the membership is something we are very proud of, but it is still dependent on the network of our lab testing partners, which is vast, but can be sparse in very rural parts of the country. We are working to provide alternatives such as in-home collection kits that can be mailed to patients. We also understand that this care model is not a one-size-fits-all approach. Our goal is to make it one-size-fits-most, but there will always be edges, and we work to find care resources and referrals for folks who need other options.
Elting: What do you want Plume to become in a post-pandemic economy?
Kirkley: I want Plume to be what it is and was always meant to be—a safe haven for trans folks no matter where one is on their gender journey. A company rooted in the community, backed by expertise and built by trans people, for trans people. A place of employment and a career launching pad for trans folks. The pandemic has opened the eyes of the world to the value of telehealth, and it is clear that it will remain a preferred model of care for many, especially trans people. Plume is and will always be a partner, guided by the wisdom and experience of so many beautiful and diverse trans voices both past and present.
