Jerrica Kirkley, Plume, on rebuilding the trans healthcare experience

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Dr. Jerrica Kirkley (she/her), co-founder & chief medical officer of Plume

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Our guest on this episode is Dr. Jerrica Kirkley (she/her), co-founder & Chief Medical Officer of Plume. Plume delivers gender-affirming care via telehealth for trans and non-binary individuals, currently operating in 41 states. Plume provides hormone-replacement therapy, such as estrogen and testosterone, as well as letters of support for gender-affirming surgery or changing name or gender markers for its patients. Jerrica and her cofounder, Plume CEO Dr. Matthew Wetschler (he/him), raised a $14M series A round of funding last year Craft Ventures.

In this episode, Jerrica and I discussed:

• Her journey to starting Plume
• Her experience as a patient and provider of gender-affirming care
• The current anti-trans political climate and Plume’s role as an advocate for the trans and nonbinary community

Beginning to 10:25: Starting Plume and coming out as a trans woman

I wanted to be a physician and work in healthcare because I really saw medicine as a vehicle for social justice.

• During her family medicine residency, Jerrica identified major gaps in care for the LGBTQ+, including in gender-affirming care for transgender and nonbinary individuals. She built out a curriculum for residents and faculty physicians to teach them how to best provide gender-affirming care with cultural and clinical competency.
• Her career post-residency focused on delivering this care in a federally qualified health center (FQHC) and teaching best practices for academic institutions, private clinics and other community health centers.
• Jerrica came out as a trans woman a few years ago and personally experienced the lack of cultural and clinical competency in receiving care as a trans patient. A 2016 survey found that one-third of individuals had at least one negative experience with a healthcare provider due to being transgender, and an additional 23% did not seek necessary care due to fear of being mistreated.

For our community, we knew [virtual care] was important beyond the pandemic because there’s a pandemic of stigma and bias that is plaguing the trans community.

• Jerrica and her co-founder Matthew Wetschler, an emergency medicine physician, identified that the difficulty of trans people receiving medical care, including Jerrica’s personal experience, alongside the emergence of virtual care, created an opportunity for a virtual care model for gender-affirming care to succeed clinically and financially.
• The COVID-19 pandemic drastically changed the prevalence of virtual care and telehealth, but virtual options were critically important due to the bias faced by trans individuals when interacting with the healthcare system.

10:26 to 16:50: Gender-affirming care is life-saving care

Gender-affirming care…at its broadest sense is healthcare that is delivered through the lens of the lived experience of trans people.

• Plume is a virtual Center of Excellence for gender-affirming care aiming to transform healthcare for all trans individuals. Plume serves transgender and “gender-diverse” patients ages 18–64 in 41 states. They provide culturally competent primary care, hormone therapy, mental health support, and letters of support that are often required for receiving gender-affirming surgery or legal services such as changing names or gender markers on official documents.

All gender-affirming care, whether it’s a letter [of support], a prescription, a support group, seeing a therapist, or an annual primary care visit for preventive health screenings…can be life-saving when done through the lens of gender affirmation.

• The logistical aspects of receiving gender-affirming care is a significant part of Plume’s focus. 57% of transgender & nonbinary youth who wanted to change their gender markers on legal documents were not legally able to do so, and this group attempted suicide in the last year at twice the rate (25%) of those who were able to change these documents 11%). This is part of why Jerrica considers non-medical services like this as life-saving care.
• Medical practitioners have limited access to educational opportunities focused on LGBTQ-focused care during training, which creates a significant disparity in having the clinical and cultural competency to deliver this care. Outside of urban areas with dedicated clinics such as UCSF and Fenway Health, there is a significant barrier to accessing care.

16:51 to 27:30: Direct-to-consumer and virtual business model and Plume’s fundraising journey

Health insurance coverage does not equal access to care…Does that health insurance acknowledge the unique needs of the trans community and specifically cover gender-affirming therapy or gender-affirming surgery…do they cover behavioral health?

Plume launched with a direct-to-consumer business model for a few reasons:

• It isn’t a given that Plume’s patients would have health insurance, in part due to the tie between employment and insurance and the discrimination that trans individuals often experience in the workplace.
• When Plume was founded, health plans weren’t focused on trans individuals and often didn’t cover gender-affirming care or have providers who could provide this care in-network.
• A DTC model allowed Plume to be fully focused on the needs of their patients without concern for constraints imposed by other healthcare organizations.

…this is not only the right thing to do, but an investable opportunity.

• Plume had to show the market that, in addition to the value they could provide to trans patients, there was a significant investment opportunity as well. The increasing visibility of the trans community is a driver. 7.1% of Americans self-identify as LGBTQ+, including 21% of Generation-Z adults, 4% of whom identify as transgender or gender diverse.
• Plume also identified that organizations that speak broadly to the LGBTQ+ community sometimes diminish or leave out the trans experience specifically, further creating the need for a company like Plume to step in.

As a trans person…walking out the door can be incredibly intimidating and even dangerous or violent…when you start to grasp how frustrating and traumatizing that can be…if I can do this from the comfort of my living room or car, or wherever that safe space is for me, heck yeah, I’ll do that in a heartbeat.

• Plume has always been a virtual model, even before the COVID-19 pandemic. In addition to expanding access to care, virtual care is often the preference for trans patients — it allows them to avoid interacting with healthcare providers and staff who may misgender them, use the wrong name or otherwise discriminate against them. These factors are harder to control in physical clinics compared to the virtual model that Plume has created.

27:31 to 32:34: How the diversity of the Plume team impacts the care they deliver and thoughts on offering behavioral health

We are building a healthcare experience around a community, and to do that, it’s critically important to represent the lived experience of our community

• Over 50% of the Plume team is transgender or gender diverse, and this lived experience enables Plume to build a product and customer experience that is positive and affirming for their patients.
• Behavioral health has been on the roadmap since Plume first launched — transgender individuals are nearly four times as likely to experience a mental health condition.
• Plume is exploring behavioral healthcare options such as prescription and non-prescription, and is learning from their community on the most valuable ways for them to access this care. While 1:1 therapy is a common offering, for Plume’s population, it comes with a different history. 1:1 therapy is a requirement for gender-affirming surgery and has previously been required for gender-affirming hormone therapy, so support group structures may be a better model.

32:34 to end: The current anti-trans political climate and Plume’s role as an advocate

There’s a shared empathy acknowledging that taking away services from trans youth that are life-saving is absolutely outlandish and unacceptable, but just feeling that this is the sentiment facing the trans community right now can be daunting.

• While anti-LGBT and anti-trans sentiment is not new, there has been a significant uptick in recent years, including from elected officials who aim to impose restrictions on trans individuals in educational, healthcare and athletic settings. In 2022, over 300 bills have been proposed in state legislatures in 36 states, already beyond the record 290 anti-trans bills introduced in 2021, of which 25 were enacted.
• Although Plume’s age range (18–64) is not targeted by the legislation and executive directives targeting trans youth, such as the Texas directive criminalizing parents who enable their children to receive gender-affirming care, they support gender-affirming care for all ages, and many of their providers have experience providing this care for the full age spectrum.
• In addition to the healthcare providers who may be directly targeted by this legislation, Jerrica believes there are others who will be hesitant to provide this care for fear of retribution or criminalization.
• In addition to delivering care to the trans community, Plume looks to be a policy leader to influence a range of issues, including standards of care for the trans community, access to gender-affirming care in a virtual setting, access to specific medications and, of course, speaking out against anti-trans legislation. Plume also partners with organizations such as the ACLU and the National Center for Transgender Equality to achieve these goals.

As an organization with a lot of trans people and a lot of amazing allies, we know that just walking into work for a lot of marginalized people, including trans people, can be hard…If we can create a work environment that encourages people to show up as their full and authentic self, it can go a long way to decreasing the burden of what happens outside of work.

• Since most of the Plume team is trans or nonbinary, they also need to focus on supporting their employees with the same issues they’re advocating for. In addition to providing mental health resources, Plume hopes to provide support by creating an inclusive workplace to reduce the burden of pressures outside of work.
• Plume advocates for a range of policy issues that aren’t specific to the trans community, including increasing the prevalence and comprehensiveness of health insurance coverage. They are also advocating for increased access to telehealth, as well as associated issues such as broadband access and reimbursement parity.
• More specific to Plume’s business, testosterone is a controlled substance, creating additional barriers to prescribing in some states, even though those restrictions weren’t enacted in consideration of the drug’s safety for gender-affirming care.

If you’re interested in transforming healthcare, have a passion for ensuring that the trans community has access to the care it deserves and needs and aren’t afraid of the startup world, definitely check us out.

• Jerrica’s advice to MBAs, be willing to learn and think big!
• Plume is recruiting across the board — you should apply if you’re interested in transforming healthcare and supporting the trans community.

To see all of the roles Plume is hiring for, check out their careers site.

We are so appreciative to Jerrica for joining us on this episode of The Pulse Podcast! Subscribe for our new releases on Twitter, Spotify or Apple podcasts.