Blood work (which we also call “labs,” short for laboratory tests) is an essential part of monitoring your health, progress, and safety here. At Plume, your medical provider orders your labs and our nurses ensure that your lab orders are sent electronically to Quest Diagnostics or Labcorp, Plume’s clinical laboratory partners. When the labs have been ordered, a nurse will send you a message via Spruce with instructions on how to schedule your lab appointment. Wait until you receive that message to schedule: otherwise there will be no lab order ready when you arrive.


Labs must be scheduled with Quest Diagnostics or Labcorp to be covered under your Plume membership. If you schedule labs with any third-party facility that is not Quest Diagnostics or Labcorp, your Plume membership does not cover the lab cost. 


NOTE: Lab facilities will ask for your legal name and sex (if you’ve already changed your name and gender marker, this will be reflected in your medical chart and at the lab). We can add a note with your chosen name in the order to make you more comfortable, unless you advise otherwise.


TABLE OF CONTENTS

Preparing for your appointment

  • There is no need to fast before your appointment. Eat and drink normally.

  • If you inject medicines, ideally get your blood drawn midway between injection days. 

    • For example, if your injections are on Tuesday, schedule your blood work for Friday or Saturday. Please do not get labs drawn the day after you inject (if you inject Tuesday, do not go to the lab on Wednesday).  If you inject on the day your labs are done, have the labs drawn first, then do your injection.

  • If you take tablets, schedule your blood draw approximately six hours after your dose.

  • If you use a gel, apply the gel away from the inside of your forearm where your elbow bends or get blood drawn in the other arm. Having gel on your skin at the draw site can skew your test results.  It is even better if you wait to apply gel until after your labs are drawn.

  • If you take estradiol AND Biotin (B7), please stop your biotin at least 72 hours before the day of your lab draw as it can interfere with your results.

  • Please be advised that most lab facilities require a mask to enter the building and to receive care. You may contact your individual lab location for more information. 


The day of your appointment

  • Once you arrive at the facility on your scheduled day and time, check in using your name exactly as it appears on your legal ID.

  • If the clinic can’t find your order, tell them Plume is a national account. This ensures they are searching using the correct information.

  • The cost of your labs is billed to Plume. There is no need to pay or use insurance. This information about your account is included in the electronic lab order. If the lab asks for a payment, have them check the order.    


After your appointment

The Plume team will reach out by 2 weeks to let you know your labs have returned, and discuss the next steps.  If you have not received your results within 2 weeks, please notify your care team in Spruce and we will follow up with Quest Diagnostics or Labcorp. 


Please know that carefully reviewing your results is very important to your medical provider. Since providers usually have many labs to review at once and they want to take the proper time to thoughtfully ensure how your results may impact your care, we kindly ask for your patience! We highly recommend creating a patient account with Quest or Labcorp, so you can see your results!  Just be aware you will always see them before our providers can get back to you.


Labs must be scheduled with Quest Diagnostics or Labcorp to be covered under your Plume membership. If you schedule labs with any third-party facility that is not a Quest Diagnostics or Labcorp, your Plume membership does not cover the lab cost. 

NOTE: Due to telehealth laws in New York, New Jersey, and Rhode Island, Quest and Labcorp must bill all New York, New Jersey, and Rhode Island patients directly for labs, and the patient must pay the lab facility. Disregard Quest/Labcorp’s regular pricing; it will be Plume’s membership rate (around $30-35) when you are sent a bill. Your membership is $90/month instead of $99/month to account for quarterly lab charges

Which tests will be ordered?

For patients on testosterone

Testosterone levels

Hemoglobin and Hematocrit (H/H)

For patients on estradiol 

Estradiol levels

Testosterone levels

For patients taking Spironolactone

Basic metabolic panel (BMP)

Estradiol levels

Testosterone levels

 

Why do I need to complete labs when receiving gender affirming hormone therapy?

Getting regular “labs” (laboratory tests) is important while on hormones. This is for two big reasons - to make sure your levels are within a safe range AND to give us a sense of how effective your regimen is.   


For patients on testosterone, we want to make sure your testosterone level isn’t too high and that your hematocrit (your concentration of Red Blood Cells or RBCs) is in a safe range. This helps us keep you as safe as possible and minimize the risks of testosterone. Your testosterone level also helps us determine how effective your dosing is. Your lab value isn’t the end all and be all - it’s just one piece of information that your medical provider will factor into a conversation with you about how you’re feeling and the changes you’re experiencing. 


For patients on estrogen, we measure estrogen levels mostly for safety. Estrogen levels aren’t the best measure of how effective your regimen is, but we check them to make sure they aren’t super high. When estrogen levels are too high, this increases the risk for side effects (such as blood clots or stroke) without giving you more benefit. Your testosterone levels are more helpful in telling us how effective your regimen is. Our goal is to see your testosterone levels dropping. Again, it’s important to know that your lab values aren’t everything - they’re just one piece of information that your medical provider will factor into a conversation with you about how you’re feeling and the changes you’re experiencing.


How does lab testing work through Plume?

Plume has partnered with Quest Diagnostics and Labcorp, two national clinical laboratories that provide convenient lab draws from thousands of sites throughout the United States. The way it works is: 

Step 1

Your Plume provider places the order for blood work.

Step 2

When your labs are due, our Plume nurses will send you a message in the Spruce app with your order. They’ll also send the order to Quest/Labcorp! 

Step 3

You’ll schedule an appointment at any Quest Diagnostics or Labcorp lab site in your state to get your blood drawn.


  • If you inject medicines, get your blood drawn midway between injection days. For example, if your injections are on Tuesday, schedule your blood work for Friday or Saturday. Please do not get labs drawn the day after you inject (if you inject Tuesday, do not go to the lab on Wednesday).  If you inject on the day your labs are done, have the labs drawn first, then get your labs done.


  • If you take tablets, schedule your blood draw approximately six hours after your dose. 


  • If you use a gel, apply the gel away from the inside of your forearm where your elbow bends or get blood drawn in the other arm. Having gel on your skin at the draw site can skew your test results. It is even better if you wait to apply gel until after your labs are drawn.

Step 4 

Within two weeks or less, your care team lets you know the results and our follow-up recommendations via the Spruce secure app.

 

Labs must be scheduled with Quest Diagnostics or Labcorp to be covered under the cost of Plume membership. If you schedule labs with any third-party facility that is not a Quest Diagnostics or Labcorp, a Plume membership does not cover that lab cost. 


A Care Team member will reach out with a scheduling link when your labs have returned, so you can make an appointment with your provider. You can then select the best day and time for your follow up appointment to review your lab results. 


Do I get labs before starting hormones?

Typically no. For most people, their estradiol and testosterone levels fall within predictable ranges. Checking these levels beforehand typically only confirms what we already anticipate and can delay starting hormone therapy.


Even if someone's hormone levels are outside the typical range, it often doesn't change our approach because responses to hormone treatment vary widely. For instance, a person assigned male at birth (AMAB) wanting to start estradiol (E) medication might have a higher testosterone (T) level than usual. We wouldn't start this patient on a higher dose of E just because of their initial T level, as E's ability to lower T can vary greatly among individuals. If a patient's T level is significantly high, raising concerns about a potential testosterone-secreting tumor, we would monitor their progress with future labs and refer them to a specialist if needed.


In cases where we suspect someone might have atypical hormone levels, we will recommend checking their levels beforehand to ensure the best approach to their treatment.


How much will I pay for labs in New York, New Jersey, or Rhode Island?

Due to telehealth laws in New York, New Jersey, and Rhode Island, Quest Diagnostics/Labcorp must bill all New York, New Jersey, and Rhode Island patients directly for labs. Then, the patient must pay Quest Diagnostics/Labcorp directly. However, even though patients in New York, New Jersey, and Rhode Island pay out-of-pocket, you receive a significant discount on labs’ regular pricing for quarterly bloodwork charges. Quest Diagnostics or Labcorp will send you a bill that charges around $30-$35. In consideration of this extra cost, your Plume membership costs $90/month instead of $99/month.

When should I get my labs?

If you inject medicines, get your blood drawn midway between injection days. For example, if your injections are on Tuesday, schedule your blood work for Friday or Saturday.  Please do not get labs drawn the day after you inject.  If you inject on the day your labs are done, have the labs drawn first, then do your hormone injection after you have completed your labs.


If you take tablets, schedule your blood draw approximately six hours after your dose.

If you use a gel, apply the gel away from the inside of your forearm where your elbow bends or get blood drawn in the other arm. Having gel on your skin at the draw site can skew your test results. It is even better if you wait to apply gel until after your labs are drawn.


Where do I go to get my labs done?

Labs can be done at any first-party Quest Diagnostics or Labcorp facility. Please note that third-party facilities are not covered. If you have any question about the facility you wish to visit, please reach out to your Care Team and provide the lab address.


Click here to find a Quest Diagnostics location

Click here to find a Labcorp location 


Plume’s medical providers are more than happy to send lab orders to a lab facility other than Quest or Labcorp. However, please bear in mind that we are unable to cover the costs of labs via other facilities at this time. You may always use your own private insurance or pay out of pocket for labs done at locations other than Quest Diagnostics or Labcorp. 

 

If your labs are performed at a Quest Diagnostics or Labcorp, the results will automatically be sent to your Plume provider. If your labs are drawn somewhere else, just be sure that the results get sent to Plume. You can do this by requesting that the lab fax the results directly to Plume at  720-815-0227 (or, if that’s not possible, you can send us the results through Spruce or [email protected]).


Please note that if you live in Arizona, the Quest facilities are labeled "Sonora Quest Laboratories." In Arizona, please find lab locations with this name to ensure that Plume can cover your labs. 


If you live in Oklahoma, there are Quest facilities that are labeled as "Quest Diagnostics" in this state. But you can also go to facilities labeled "Diagnostic Laboratory of Oklahoma."


Where do I get my labs if I’m using my insurance for Plume?

If you are using eligible health insurance to help cover the costs of Plume services, please note that some insurance companies only cover the cost of labs at either Quest Diagnostics OR Labcorp, but not both. For example, if your insurance company only covers the cost of Labcorp but not Quest Diagnostics, you must get labs at Labcorp to be covered under the Plume Membership with Insurance. You can double check with your insurance by calling the customer support number on the back of your card. 


How often do I need to get my labs done?

When you start taking hormones or start again after a significant break, you usually need to get lab tests done every 3 months. Once you've been on a steady dose for a year or more, we might be able to wait longer between tests.


It's really important to do your lab tests on time and then have a visit with your Plume provider. If you don't do your tests in a timely manner, your healthcare provider won't be able to give you more medicine. We don't want you to miss out on your hormones, but keeping you safe is the most important thing. Help us take care of you by being consistent!


What if I can’t get to a Quest or Labcorp?

We apologize that there are no Quest Diagnostics or Labcorp locations closer to your area. As Plume is only contracted with Quest and Labcorp, we are unable to accommodate the cost of alternative lab facilities at this time. Your other options are: 

  • Go to your primary care provider for testing. Your Plume team will provide you with the exact tests that need to be performed and you can bring this information to your primary care provider.

  • Pay out of pocket for testing at an alternative facility

  • Ask your private insurance company to cover your tests. You can try calling the number on the back of your insurance card to speak to a representative. Be sure to have the list of the labs that you will need when you make this call.


All of these options have varying costs. You could pay $100-200 for your quarterly labs, depending on whether you use insurance or not. To guarantee lab payment coverage through Plume, it must be done at a Quest Diagnostics or Labcorp location.