About labs

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. 

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.