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 or annual 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 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 transition and work with you to establish a treatment plan

  • Quarterly follow up appointments with your provider

  • Prescriptions for gender-affirming medications and everyday wellness treatments sent to our delivery pharmacy or your local pharmacy 

  • 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 the Community Hub, our private online community, where you can join trans-led support groups, attend exclusive events, chat in discussion spaces, read educational resources, and connect with other trans and gender diverse people

  • 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?

Your provider may prescribe gender-affirming medications like hormones (testosterone, estradiol, progesterone), hormone blockers (spironolactone, finasteride, or dutasteride), and medications to support sexual function (such as sildenafil or tadalafil). They can also help with everyday health concerns like hair loss, acne, insomnia, allergies, nicotine cessation, contraception, anxiety, and depression. 


Your Plume membership doesn’t cover the cost of medications, but it does include access to prescriptions and refills through your provider.

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

Yes. Plume provides medical support letters. 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 gender-affirming care 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.

Does Plume provide gender-affirming surgery?

No. We do not provide gender-affirming surgery. 

How do I make an appointment?

Please see How To Schedule & Manage Your Appointment. 

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. 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! 

Can someone under 18 use Plume with parental consent?

No. 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. 

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.

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 composed 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?

No. 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. 

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. 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.