TBD Health Is Redefining Sexual Healthcare
After years of helping each other navigate challenges in the fraught landscape of sexual healthcare, Daphne Chen and her co-founder Stephanie Estey saw a gap in the market for supportive sexual healthcare that makes women feel empowered rather than embarrassed or uncomfortable. Their solution is TBD Health: a platform that first and foremost increases access to sexual healthcare through at-home STI testing and other services, and that speaks to women through a lens of sex positivity and safety rather than shame.
Last year, Daphne and Stephanie participated in Human’s entrepreneur-in-residence program and launched their at-home STI testing kit, enabling easy, affordable testing in the privacy of home. After realizing that a hybrid model would allow them to provide even more comprehensive care, TBD opened their first in-person clinic in Las Vegas where they are combining world class patient care with seamless technology.
We sat down with Daphne to talk about how TBD is delivering a new kind of patient experience, how state legislation is changing the game for access to sexual health services, and the best ways to dismantle stigmas around STIs and sexual health.
What inspired you to start TBD?
The first time I went to the gynecologist, I was 24 and asked for an IUD. My doctor refused to give me one because she didn’t approve of the fact that I was dating actively and not in a long-term relationship. I felt really disenfranchised and dismissed, and it set the tone for how I expected to be treated by healthcare providers. When you feel shame and discomfort with someone you’re meant to trust, it prevents you from seeking care in the future.
Stephanie and I started TBD because we have both navigated a lot of sexual health challenges within the traditional healthcare system. We’ve known each other since our early 20s and are now in our mid-30s, so that’s years of being there for each other as we navigate sex, dating, and sexual health. We were always a part of the same whisper networks of women that would help each other find the right sexual health care provider — providers you could be open with about your sexual history and receive care that wasn’t going to alienate you.
We wanted to create a service that allows women to be their full selves and gives them the resources they need to have a healthy, satisfying sex life from puberty to death.
How are you building your brand with your core customers in mind?
We set out very deliberately to build a brand that holds sex positivity at its core because that is missing in healthcare.
We saw a massive gap in the market around care that makes you feel empowered in your sex life instead of ashamed or uncomfortable. We are building a brand that speaks to modern women, creates a safe space they can trust, and gives them the tools they need to engage in a fulfilling sex life that evolves over time.
A core pillar for us is that your sex life and reproductive health shouldn’t be conflated, which as a society we have a tendency to do. It’s very heartening to see the increase in resources available around fertility and reproductive care, but that’s only a small percentage of your sex life as a woman.
How are you thinking about delivering a patient experience above and beyond testing?
At TBD, we’ve challenged our team to rethink what it means to deliver the best possible patient care, moving beyond traditional operational metrics like patient volume (which result in 15 minute average visits) and building our company’s goals around the metrics that will serve that end. Our approach allows us to listen to our patients more effectively, which means we have a better sense for what services they might need or find helpful.
When we hire, we’re very deliberate about finding the right values-match with our clinicians. During onboarding and training, we make sure they have the tools to provide care that is sex positive and gender affirming.
Sometimes we get feedback from our clinicians that they wish they had this coursework in nursing or medical school. In the traditional system, you learn how to treat the body. You don’t learn how to treat the person. We’re reeducating our clinicians around engaging with a person and the emotional and psychological needs that they have.
What have you learned from your Las Vegas pilot? Why did you decide to open an in-person clinic?
When TBD launched, our first pilot was an at-home STI screening service available in six states. Our original thesis was that STI testing from home was more convenient, more accessible for folks that live in reproductive health deserts, and a great education tool because you’re learning about your body as you go through the self-administered protocol. All of that has held true, but we started to expand into a hybrid model because our customers were asking for services that are not better over telemedicine, like a physical exam or a skin check.
At the Care Hub, we’ve learned that being in-person is an incredible way to accelerate trust-building between patients and providers. Then, patients can convert into online customers and manage their sexual health from home with a full safety net underneath them.
California just required health insurance companies to cover at-home tests. Is this an indication of a broader trend?
We’re starting to see several states adopt or bring similar legislation to their state Congress already. California being the first is incredibly influential because of its size and influence over payers. If you read the legislation, they’re very explicit about the fact that it’s about enhancing access, which has been a problem for a long time even before COVID. Access to sexual health services have been defunded in many states due to state politics or the lack of clinicians, or resources being rerouted to COVID support. It’s really important legislation and we see California as the first domino to fall of many.
What are the best ways to dismantle the stigmas around STIs and sexual health?
Dismantling stigma really starts with more open communication and widespread conversation. Conversations about sexual health tend to start in whisper networks among close groups of trusted friends, but having these conversations in public really helps others feel less alone.
A lot of these conversations are happening on forums like Reddit, which tells you that there is a lack of infrastructure for people to access support, answers, and reliable sexual health content. There’s been increased interest in investing in sexual health over the last few years, which we think will help bring new solutions to market around sexual health education.
COVID itself has also helped us dismantle the stigma around STIs because the conversations we have about COVID are similar to the ones we need to have around STIs. Are you masking? Have you been vaccinated? Have you been tested? Are you socially distancing? A face mask is basically a condom for the face. These conversational tools can now be leveraged to make STIs a more approachable conversation for people.
Who inspires you?
Dr. Ina Park has been such an incredible advocate and inspiration to us. She’s been totally fearless in wanting to change how we talk about STIs and a touchstone for progressive thinking around sexual healthcare. She’s a professor at UCSF, actively practicing clinician, consultant for the CDC, and author of the definitive book about stigma and STIs, Strange Bedfellows. She has an incredible bird’s eye view of the public health implications of STIs and a deep understanding of what it means to engage with patients on a day-to-day basis facing STI concerns.
Interested in joining the team? TBD Health is hiring a VP of Sales, Product Manager, Senior Software Engineering Manager, and a Social Media and Community Manager.