TABLE OF CONTENTS

How does Plume work?

Plume provides gender-affirming care directly from your smartphone. Our experienced Care Team understands the unique needs of the trans community.  Membership with Plume includes everything you need to start, continue, and maintain your gender-affirming hormone treatment (GAHT, sometimes called HRT). We know everyone has different goals for their transition and we are here to help you navigate your gender journey. 


Plume members will have their initial first intake appointment with their provider via video call. After that, you will have the ability to send a message via chat to your Care Team at any time, and we will respond within 1-3 business days. You will have follow-up appointments with your provider to check in on how you are doing, review labs, and inquire about any additional concerns. A Care Team member will reach out to you in a few months for your quarterly follow-up appointment. If you want to have another video call with your provider at a later date, let your Care Team know so we can help coordinate that for you! 


Do I have to pay for follow up appointments?

If you are signed up for a self-pay membership, all follow-up appointments are included in your monthly rate. If you are signed up for a membership with insurance, a co-pay is required for follow-up appointments (the cost of your co-pay depends on your individual insurance policy).


What services does Plume provide?

Plume offers a monthly membership which includes:


Gender affirming healthcare by a licensed medical provider who is an expert in trans healthcare


Digital video appointments with your medical provider, who will review your goals for your gender journey and work with you to establish a treatment plan


Quarterly follow up appointments with your provider


Prescriptions for gender-affirming medications as medically appropriate sent to our delivery pharmacy or your local pharmacy 

These medications may include hormones (testosterone, estradiol, progesterone), hormone blockers (spironolactone, finasteride, dutasteride), hair loss medications (finasteride/dutasteride), and sexual function support medications (sildenafil/tadalafil)


Ordering, analysis, and cost of all recommended labs (done at your local Quest Diagnostics or Labcorp)


Ongoing progress monitoring with quarterly evaluations and treatment adjustments to make sure you’re healthy and on track


Medical letters for legal name or gender marker changes


Medical letters of support for surgery


Access to a six-week series of support groups, guided by a facilitator from our community


Injection instruction and live injection support, to help you feel comfortable taking your medication


Access to your gender-affirming care team who can provide resources, guidance, and answer any questions in our app


What medications can my provider prescribe me?

Prescriptions could include hormones (testosterone, estradiol, progesterone), hormone blockers (spironolactone, finasteride, dutasteride), hair loss medications (finasteride/dutasteride), and sexual function support medications (sildenafil/tadalafil). Plume membership does not cover the cost of your medications, but does ensure that your prescription and refills are available for you.


Does Plume provide letters of support for gender-affirming surgery?

We do! Plume provides medical provider letters for both Plume members and non-members. If you are a Plume member, these letters are included in your membership. If you are not a member, you can pay a one-time fee of $150 for an appointment with one of Plume’s medical providers. Letter requirements vary from surgeon to surgeon and state to state, so please ensure you have a surgeon selected and get the letter requirements from them before you request a letter.

Unfortunately, we do not provide letters from behavioral health professionals (e.g. therapist letters) at this time and can only offer letters from a medical provider. 

To prepare your letter, you’ll meet with one of Plume’s licensed medical providers to determine if you are medically eligible for the letter. The rest of the care team will be able to provide additional resources for support. For letters, we have a guaranteed one week turnaround time.


How much does Plume’s surgery letter writing service cost?

We offer a one-time surgery support letter writing service for $150 for non-members. For Plume members, all letter writing services are included in the cost of your membership. 



Does Plume provide letters for name or gender marker changes?

Yes! To change the name or gender marker on your identification documents (driver’s license, social security card, passport, birth certificate), you often need a letter from your treating medical provider or a form signed by them. You must be a member with Plume to receive name and gender marker letters. We do not provide one-time letters for name or gender marker change. Here are some great resources:

    

Does Plume provide behavioral health?

Plume members can enjoy access to free support groups led by a trauma-informed trans or nonbinary facilitator. We are looking forward to rolling out more behavioral health services in the future! We encourage a relationship with a behavioral health provider for continued support, as we believe this is a valuable resource for all people. If you are seeking mental health support, we can help you find a local therapist in your area that is competent in gender-affirming care. We can also provide resources for you to connect with a remote therapist who can work with you from the comfort of your own home via video, text, or phone such as:


Does Plume provide gender-affirming surgery?

We do not provide gender-affirming surgery, but we do provide letters of support for surgery for both members and non-members (when medically appropriate to do so). Letters of support are included in the price of membership or as a one-time service. We will also help you navigate the process by providing a list of surgeons and referrals if you’re just beginning your journey or need help finding a provider who can perform your desired procedure(s).


*Please note we cannot provide a behavioral health letter of support from a therapist at this time. Letters are included for active members. Additionally, some surgeons will require a pre-operative clearance from a medical provider before surgery. Plume is unable to provide a pre-operative clearance as this requires an in-person visit.


How do I make an appointment?


Step 1 
Visit https://getplume.co/get-started/ and fill out info accordingly. Questions include your state, zip code, the service you are interested in, chosen name, pronoun, email, birthday, your Medicare status, and how you heard about us.


Step 2 
You will be invited to download our secure communication app Spruce on the next page if you are eligible to use Plume. You’ll need your ID, credit card, and a recent blood pressure reading to complete the process.


Step 3 
Once you have downloaded the app, login with the information you used during sign-up. 


Step 4 
Select the pre-filled button that corresponds with the service you are interested in. Continue to follow the automation by selecting the pre-filled buttons that correspond with your information.


Step 5 
Proceed to fill out medical intake forms and pay the $99 registration fee.


Step 6 
Once you have paid for your registration fee, you will be able to access a calendar to book your appointment.


Step 7 
Select the day/time that best suits your schedule.


Step 8 
Confirm with your Care Team via Spruce if you were able to book an appointment. If not, let us know and we will reach out via Spruce to assist within 1-3 business days.


How long do I have to wait for my first appointment? What if there are no appointments available in my state?

Appointment wait times vary by state and are based on provider availability. You can check the current status of our provider availability in your state here. If once you have paid the registration fee and see there are no appointments available when you sign up, you will have the option to be added to a state-specific waitlist. We will contact you as soon as appointment times are available, and you will not be charged your monthly membership fee while you are waiting. 


We are always working to add more availability, and help you connect with the care you need. 


Is a video appointment required?

Yes. All of your Plume appointments are conducted via video call. We do require you to be on camera (at least briefly) to confirm your identity. This is to ensure that we comply with telehealth laws and regulations. If you prefer to switch to texting or need other accommodations to communicate with your care team, let us know! 


To ensure a smooth and effective appointment, please follow these guidelines:


1. Find a Private Space: Make sure you are in a quiet, private space at the time of your appointment. This helps maintain confidentiality and ensures you can focus on the conversation.


2. Avoid Distractions: Ensure there are no distractions during your call. This means not being in a public place or involved in other activities.


3. Do Not Drive: If you are driving when your provider calls, the appointment will need to be rescheduled. Please be stationary and safe during your appointment.


By following these steps, you help us provide the best care possible. Thank you for letting us take care of you!



Can someone under 18 use Plume with parental consent?

We are very sorry that we cannot provide services for anybody under the age of 18. If you are under 18 and looking for a provider in your area, the World Professional Association of Transgender Health (WPATH) Provider list may be a helpful resource. You can search by both city and state. Looking at the WPATH directory, a provider within any of the following specialties may be able to provide GAHT: pediatrics, endocrinology, or internal medicine/primary care/family medicine. Within these specialties, you'll want to look for a provider that is listed as a Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioner (NP), resident (a doctor in training), or Physician Assistant (PA).  Any counselor or psychologist should be able to provide behavioral health services.


We are happy to help support you how we can and we wish you all the best. When you are 18 (or 19 in Nebraska or Alabama), Plume is ready to be your care provider!


What can I expect from my first appointment?

Your first appointment is our chance to get to know you and learn more about your goals for your gender journey. The intake process includes a 20-30 minute video call with your provider through the Spruce app. During this call, we will review your medical history and discuss the services you want to use. You and your provider will come up with a care plan together that is medically safe, sustainable, and aligned with your goals.


If, by the end of your appointment, you feel comfortable with your new care plan and want to move forward, your provider can usually send your prescription to your preferred pharmacy at that time. You’ll be on your way!


Who is my care team and how do I communicate with them?

As part of your Plume membership you have unlimited access to a dedicated care team that is committed to providing thoughtful, expert, and accessible care that celebrates and enhances the quality of life for every trans person. Your care team is comprised of a medical provider, registered nurses, emotional support specialists, and Care Coordinators. Plume’s medical providers are all trans-specialists, and many are trans themselves.


Your Care Team will respond to your message within 1-3 business days through our secure communication app Spruce during the hours of Monday-Friday from 8am to 6pm (Mountain Time). You are also welcome to call and leave us a voicemail at 720-897-3749.


What are your business hours?

Monday-Friday from 8am to 6pm (Mountain Time).


Can Plume be my primary medical care provider?

Plume is not a primary care provider. We are designed to support your gender journey and other health concerns through services that help transgender folks access the care they need to thrive. We strongly recommend that all patients maintain a relationship with a primary care provider or clinic, so they can receive care for  other medical conditions and routine check-ups. If you’re having trouble finding a primary care provider who is sensitive to gender diversity, we are happy to offer our recommendations.


What if I don't have a smart phone?

If you do not have a smartphone, you can message and video call with your provider through the desktop version of Spruce from any computer. However, downloading the app on a smartphone or tablet is required for the initial sign up process because our medical intake forms can only be completed through the app. If you are able to access a smartphone or tablet to complete the signup process, you may resume communication with your care team via desktop. Please note that without access to the app, you may not receive important and/or time-sensitive notifications about your care in a timely manner. We suggest erasing the app from any devices that are not yours for your privacy and frequently checking your Spruce account for new messages if you opt for a desktop-only experience. 


What is the difference between appointment-based (synchronous) and asynchronous care? 

Depending on the nature of your request/concern, the Care Team will provide a link to schedule an appointment with your provider. This would be considered a “synchronous” visit. Synchronous care means you are meeting with your provider at the time you are receiving medical care. You would schedule an appointment and then meet with your provider on that chosen day and time. A Plume clinician discussing your lab results, adjusting your dose or starting a new prescription, or answering health concerns during a telehealth call are all examples of synchronous care. 


Asynchronous care means that you and your provider communicate health concerns without meeting with each other for a video visit. You might send a message asking a question and then your provider will respond a short time later with an answer. Since the communication is happening at different times, this is considered asynchronous care. 


What are the benefits of synchronous care? 

Synchronous care means we can do more! Appointment-based care enables our clinicians to develop a deeper understanding of your health needs and provide you with a more robust and elevated care experience. By dedicating time specifically to privately discuss health concerns, we are able to expand the scope of services we offer outside of GAHT. Additionally, Plume members using eligible insurance to reduce their membership fee will be able to use their insurance for all follow-up appointments with their provider. Insurance companies will only cover the costs of virtual video appointments, not asynchronous care. Shifting to an appointment-based care model allows our members to use their insurance for costs of GAHT and for our expanded services available to Plume members.


When should I schedule an appointment with my provider?

You should schedule an appointment when you want to discuss or make changes to your care plan, such as adjusting prescriptions, discussing lab results, or have any concerns with GAHT. If you want to discuss non-urgent side effects or symptoms you are experiencing, you will also need to schedule an appointment with your provider. Let us know you are interested in setting up an appointment and a Care Team member will send you a link to schedule.


Please note that if you are experiencing urgent side effects, our providers do not provide emergency medical health care. We advise you to go to your nearest clinic or hospital if you are experiencing symptoms that require immediate medical attention. 


How many appointments do I need to receive my medication?

There is not a specific number of appointments required to receive your medication. The frequency of visits depends on your individual care. The Care Team will remind you when to schedule a follow up appointment, such as when your lab results come in or when you run out of refills and need a new prescription sent. If you want to adjust your medications or have any additional concerns you want to discuss with your provider, you will have these follow up appointments in addition to the continuous follow-up appointments regarding labs and new prescriptions. 


When is the Care Team still available to answer questions?

Everything from providing supportive resources, billing questions, membership information, and writing letters of support, the Care Team is available Monday-Friday from 8am to 6pm (Mountain Time) to answer your questions. 


We understand that navigating healthcare can sometimes feel overwhelming. With appointment-based care, you'll have the opportunity to engage in meaningful discussions with your provider, whether it's about lab results, adjusting prescriptions, or addressing other health concerns. This personalized approach ensures that your journey with us is characterized by compassion, respect, and empowerment catered to your specific needs and goals.