Service provides medicalized trans ‘hormone therapy’ online

Plume "provides everything you need to start, continue, and maintain your gender-affirming hormone treatment." The service is available to anybody between the ages of 18 and 65.

Contrasting Plume with traditional in-office treatments and experiences, Plume says they have "no gatekeeping and no letters required to access care," stating that offices "may require prior diagnosis or therapist letters for gender-affirming care ."

In regards to prescription refills, Plume says they have "ongoing prescription refills with an active membership ," while traditional offices "may require additional follow up visits for prescription refills ."

The company also states that the care team is "trans-led" and will always "use your chosen name and pronouns ," while traditional offices "may or may not have experience with the trans community" and patients have the "potential of being misgendered in person ."

For a monthly membership fee of $99 per month, users receive digital video appointments, prescriptions for gender-affirming medications, letters for surgery or gender-marker changes, and injection instruction and live injection support.

All patients have to do to get started is fill in a form, enter credit card details, download their app, and then book an appointment with one of their experienced "gender-affirming" care providers.

During the appointment, the patient's goals and desires are discussed and a "safe" treatment plan is created.

Most people get their prescription sent to the pharmacy the same day as their appointment.

Two types of hormone therapy programs are offered: Estrogen+ and testosterone.

Estrogen+ includes estrogen, testosterone blockers, androgen blockers, and progesterone. The website states that "mental health, especially anxiety and depression, can … improve soon after starting estrogen."

Testosterone is offered via injection, or as a gel or a patch. The website states that "some folks notice feeling better emotionally shortly after starting T - in particular, they report less anxiety and more confidence."

The company also offers a letter of support, with the website boasting about giving a medical letter of support for surgery after just one digital appointment, with a one week turnaround time. They note that they "cannot provide a behavioral health letter of support from a therapist at this time."

The Plume Healthcare Team consists of 34 healthcare providers, a care team of 21 members, and 3 emotional support staff. All have their pronouns on display.

The company is active in Oregon, Washington, California, Nevada, Arizona, New Mexico, Colorado, Wyoming, Nebraska, Oklahoma, Texas, Iowa, Missouri, Michigan, Wisconsin, Illinois, Ohio, Kentucky, Tennessee, Alabama, Georgia, Florida, North Carolina, Virginia, Maryland, Pennsylvania, New York, Massachusetts, Vermont, and Maine.

The company offers only their Estrogen + services in Montana, Idaho, Utah, Minnesota, Arkansas, Louisiana, West Virginia, Connecticut, Rhode Island, and Vermont.

The company’s services are not available in North Dakota, South Dakota, Kansas, Mississippi, South Carolina, and Delaware.

While the website has many glowing reviews from customers, not every review is positive. One mother took to Facebook saying:

"How in the world is this legal. My daughter was going thru the proper process with doctors and therapists to determine if she wanted to transition to male. She is Bipolar, has Tourette’s, and had is borderline personality disorder suspected. She is chasing multiple medical issues as well and they are unsure what she has but it causes sudden muscle tone loss and slurred speech.

"She contacted your group, got an appointment and with NO LAB WORK, NO COUNSELING, no medical or mental health history obtained other than her word of mouth (which due to bipolar she is impulsive and dishonest) has a prescription for hormones to transition to he/him. She got a very small document to read and was told there is no risk.

I talked to mental health professionals and therapist she is seeing and they are flabbergasted and terrified and called it unethical."

Another concerned mother wrote, "This is so dangerous! My child got a prescription THE SAME DAY with little to no medical background, no physical, no lab work."

"If this is what you want do it the safe way through true professionals and not an app. If you want it and it’s worth it and done SAFELY, it is not this easy. This APP could have caused serious harm to my child who has chronic illnesses, and abnormal labs. We are still waiting a REAL doctors appt to see what damages may have occurred. Please seek a professional and see them in person!! This is not safe!"