The impact of gender-affirming care

Countless studies have revealed that gender-affirming care saves lives. Transgender and gender-diverse individuals with access to said care are proven to have a significantly decreased risk of suicide, psychological events, and substance abuse. 

Despite these findings, only seven states in the United States prohibit health care discrimination based on gender identity.

For transgender and gender-diverse youth, the numbers are even grimmer. Fifteen states are working to ban gender-affirming care for people under the age of 18, which would leave 58,200 more U.S. citizens lacking valuable health care. 

Although some states like Colorado mandate that insurance companies cover gender-affirming care, many barriers remain. 

“Health insurance coverage doesn't equal access to care, and doesn't necessarily equal good care,” Kirkley.  

According to Kirkley, even the best insurance in the world doesn’t guarantee adequate health care, because there is always a risk of encountering a dysphoric environment. 

And it’s not just the transgender community who suffers from this lack of care. Kirkley noted, “If we know that gender-affirming care saves lives, improves mental health, improves quality of life, that's what we're all going for. We all want to be happy. We all want to be healthy. And so I think if we can do that in any way for any community, transgender community or otherwise, we're all better off.” 

A ‘lightbulb’ moment 

Kirkley co-founded Plume with Dr. Matthew Wetschler, a close friend she met in medical school. Kirkley was in the process of coming out as a transgender woman herself. Between her personal experience in seeking medical care and her time volunteering at public clinics, the lack of access to gender-affirming services had become very clear. 

While brainstorming with Wetschler, the two found a valuable overlap — Kirkley’s passion for gender-affirming care, and Wetschler’s penchant for expanding access to medical necessities through apps. Thus Plume was born, and its mission to “transform healthcare for every trans life.” 

Plume provides patients around the country with access to a range of gender-affirming care such as hormone therapy, testing, and letters of support for gender-related surgeries, all through a lens of both clinical and cultural competency.  

Patients can access their care team from the safety and comfort of home and rely on confidential, supportive services from qualified doctors - many of whom are fellow members of the transgender community. 

The name “Plume” came to the cofounders as a representation of both an individual and a community.  

Kirkley explained further, “So you have plume as a feather, something that, you know, can be very ornate when we think about nature and animals and individuality and expression. But then you have plumage, which is a collection of all those feathers.  And where the community aspect comes in. Yes, each one of those feathers is individual and it's beautiful in and of itself. But when they all come together they make something even more beautiful.” 

Kirkley and Wetschler began Plume three years ago with a sign on a therapist’s door in Colorado Springs supplemented by a Facebook post saying “stop by.” Since then, Plume has expanded to 42 states and has served around 16,000 patients. 

“It’s truly a ‘pinch me’ moment,” said Kirkley. 

With numbers comes opportunity 

The high population of transgender individuals being served presents Plume with opportunities not typically affiliated with a telehealth app — one of which is informing policies on the rights of transgender and gender-diverse people.  

Having so many patients allows Plume to gather important data. They partner with legislative offices to share their data and consult based on their results. 

"We can show that 50,000 transgender people participating in a particular way of receiving care — gender-affirming care in particular, gender-affirming hormone, therapy or access to surgery — actually results in life-saving moments and improving mental health. That becomes incredibly hard to argue with,” Kirkley said. 

Kirkley and Wetschler also recognize an opportunity (and challenge) to deepen Plume's understanding of intersectionality within the transgender community. Kirkley acknowledges that transgender people are not a monolith, and there is room for even more levels of representation in Plume’s serviced offerings. While over half of the staff is trans-identifying, the company is expanding its mission to provide more levels of representation. 

“When it comes to other elements of background, whether that’s race and ethnicity, religious, spiritual background, neurodiversity — the list goes on. So having all those people be a part of the process that is thinking about our clinical workflows, that's actually providing care to patients, who are on our operations teams,” said Kirkley.  

She said Plume considers intersectionality in every element of the staffing process, from recruitment to hiring and support. They’re also considering these elements in access and outreach. 

Currently, Plume does not accept insurance. They are hoping to expand the community they serve by creating alternative payment options and ensuring insurance compatibility. And while providing access to gender-affirming care itself is proven to improve the mental health of different populations within the transgender community, Plume is working to deepen that experience for patients by providing depression and anti-anxiety prescriptions, as well as peer support groups. 

Reflecting on the journey 

Looking back on the three-year journey Plume has had, Kirkley recognized personal growth as well.

“That personal journey has followed my career journey, at least this career shift and starting Plume almost side by side," she said. "So I have gone through this kind of adolescence, if you will, as a transgender person while our company has as well, and I have grown alongside it. “ 

As for the future of Plume?  

Beyond their immediate hopes to increase access to their services financially and expand their scope of care to being more holistic, they hope to amplify their impact. More specifically, to shift the societal restrictions that have created the barriers Plume was created to break down — globally. 

“There are many countries who struggle with having available gender-affirming care for the same reason that we struggle here,” Kirkley mused. “I think really the opportunities are endless.” 

Elle Naef is a digital media producer at Rocky Mountain PBS. You can reach her at ellenaef@rmpbs.org.