Plume vs Folx: What’s the Best Online Trans Healthcare Provider?

Plume and Folx are two new health services slated to radically change the way trans and non-binary individuals can get access to transition-related care. For far too many trans people in the US, finding a provider that is both affirming and competent can be almost impossible. In fact, nearly a third of trans people report that they were turned away from a doctor in the past year on the basis of their gender identity or expression. 

It’s clear that things need to change. Luckily, online / remote providers are starting to pop up to specifically meet the health needs of trans and non-binary people. Plume and Folx are just two online healthcare providers that aim to make accessing, receiving, and managing transition-related care easy, safe, and even pleasant. Each could significantly change the way the healthcare industry interacts with trans / non-binary communities, which are chronically underserved, and we can expect both to gain traction.

So which of these two online providers is right for you, Plume or Folx? In this in-depth guide, we’ll break down everything you need to know about these two services, their features, costs, and the pros and cons of each.

The Changing World of Transgender Healthcare

For many trans and non-binary people, getting access to even the most basic basic healthcare can be an uphill battle. From encountering transphobic providers, to those who inaccurately characterize trans identities as mental illness, to those who are simply afraid to work with trans people, almost every trans / non-binary person has a story (or five!) about a provider who did more harm than good. 

For trans / non-binary people who want to medically transition, obtaining access to gender-affirming care can be a matter of life or death. Unfortunately, knowledgeable and affirming transition-related providers are often hard to come by. Sometimes, even a doctor who is willing to prescribe hormone replacement therapy (HRT) may be unwilling to write surgical or name change recommendation letters (or may be inexperienced at doing so). They may have misinformed and/or transphobic frontline staff, or they might send patients to outside labs for blood work, where the patient can, and often does, run into a host of challenges. All of these issues are only compounded by other factors that work against trans people – race, ethnicity, socioeconomic disadvantage, language barriers, ‘passibility,’ geography (i.e. living in a rural area) and so on. There are so many reasons why trying to find compassionate and informed care can become a difficult, overwhelming, and even traumatic task.

This is where online healthcare platforms like Plume and Folx, both of which were specifically created to ameliorate some of these issues, may prove to be so valuable for trans and non-binary communities. Let’s take a look at both platforms and their offerings, so that you can make a more informed decision about which company may be right for you. 

Review of Plume: What does it offer?

Plume is an online healthcare platform specifically designed to help trans and non-binary people get access to gender-affirming HRT. This company boasts “first-in-class, evidence-based medical care,” all from the convenience of one’s smartphone. Plume’s entire team is made up of trans and queer people, including all of the medical professionals you’ll have access to via the app, so you’ll have a good chance of accessing truly gender-affirming care.

Plume is currently available in 33 states and is rapidly expanding (see map below for full geographic availability). Anyone between the ages of 18 and 65 can use the platform, except for Nebraska, where you have to be at least 19. 

“We believe healthcare should be easy, convenient, and center the unique needs of the trans community,” reads the company’s mission statement. “If you are trans, it doesn’t always mean you need or desire gender-affirming hormone therapy (“GAHT” or “HRT”), but if you do, we are here to help. You are our priority.”

Features of the Plume platform

• Direct access to healthcare providers who specialize in trans care. For everything from questions to appointments, Plume users are able to avoid the dreaded phone tree, and the often-untrained and/or insensitive front desk personnel at a typical provider’s office.
• Access to medical letters of support for transition-related surgical procedures, as well as name and gender marker changes.
• Access to an entirely trans and/or queer medical team. Many of the other individuals employed with Plume are also trans and/or queer as well.
• Access to healthcare directly via the Plume app, a user-friendly platform. You engage in virtual appointments with your physician in order to create a plan based on your personalized, transition-related goals.
• Once you and your provider have created a personalized plan, they then send your medication to your preferred pharmacy. Such medications can include hormones (like testosterone, estradiol, and progesterone); hormone blockers (like spironolactone) and hair loss prevention medications like finasteride and dutasteride.
• All necessary labs, evaluations, and treatment adjustments are included in your Plume membership.
• Injection support and instruction.
• Recommendation letters for surgeries, name and/or gender marker changes.

How much does Plume cost?

Plume costs $99 per month, which includes your initial evaluation, labs, letter-writing, sending medication and supplies to your pharmacy, and 24/7 access to virtual care via the app. It’s worth noting that this subscription fee does NOT cover the cost of hormone replacement medication(s), however, which Plume estimates at an additional $20 per month. This package does include an initial medical evaluation, a letter of support, virtual access to a care team, and ongoing virtual consultation.

Aside from this monthly subscription fee and the additional cost of HRT, Plume also offers a one-time letter-writing service if you plan on having transition-related surgeries, or a name and/or gender marker change. Their letter-writing service is designed for those who do not want or need to purchase a Plume membership, but who need a medical letter of support. Members of Plume have access to this service for free, and non-members pay $150. 

Does Plume accept health insurance?

Plume does not take insurance at this time, and your insurance company will not cover the cost of a Plume membership. However, your insurance company may cover the cost of your medication(s).

Plume positions itself as a viable alternative to insurance, especially for individuals with insurance plans that are not trans-inclusive. With a plan that does not cover transition-related care, obtaining access to HRT/GAHT could mean paying for your visits, labs, follow-up appointments, etc. — all of which could amount to thousands of dollars out-of-pocket. With Plume, all of that is covered with one low monthly fee (with the exception of medications).

Where is Plume available?

As of June 2021, Plume is available in the following states (as listed on their website):

• Arizona
• Alabama
• Arkansas
• California
• Colorado
• Florida
• Georgia
• Iowa
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Missouri
• Nebraska
• Nevada
• New Jersey
• New York
• North Carolina
• Illinois
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Texas
• Tennessee
• Vermont
• Virginia
• Utah
• Washington
• Wyoming

You can’t pay for Plume with Medicare, and recipients of Medicaid in Colorado and Kentucky can’t use Medicaid to bill for the service (Plume says that these restrictions are due to state laws and/or Medicare billing restrictions). 

Review of Folx Health: Is it legit?

Folx is a queer and trans healthcare platform that offers hormone therapy, and a variety of other services like PrEP and STI kits, with “no ignorance, no judgment, no hassle.” Available to anyone over 18 years old, this platform is unique in its focus on providing direct care for trans patients. You can simply gather your existing medical history and Folx will help you pick up wherever you left off. 

The company’s focus is providing safe, convenient medical care without the threat of encountering a potentially transphobic clinic or pharmacy. Everything you need, including medications for HRT, and even some lab testing kits, can be sent directly to your home. 

The program starts with completing your medical history online and a quick virtual visit. From there, you’ll be able to get your labs ordered — whether that be for an in-person visit or an at-home lab kit. After you receive your first prescription, your medications and supplies are refilled and sent directly to you on a regular basis. One thing to note: unlike Plume, Folx doesn’t yet have a mobile app.

Features of the Folx Health platform

• Unlimited virtual access to queer and trans clinicians and medical staff.
• Complete kits for your medications, labs, and supplies are delivered directly to your door. This way, there is no need to put yourself in the position to feel unsafe at a potentially transphobic clinic or pharmacy. 
• Prescriptions currently include estrogen, testosterone, and erectile dysfunction treatment. (Coming soon to Folx: STI testing kits, PrEP, and skin/hair care). 
• Supplies delivered-to-door include needles, syringes, alcohol swabs, a sharps container (for used syringes), and more.
• Access to letters for name and/or gender marker changes and transition-related procedures/surgeries. 
• Access to Folx’s library, where you can discover answers to common trans/queer healthcare questions, access how-to guides and HRT instructions, etc. 
• Soon, Folx will start offering at-home kits to collect blood samples so you don’t have to brave an office. Labs that cannot be completed at home will be sent to your nearest Quest Diagnostics.

Where is Folx available today?

Folx is growing steadily and will likely be available in more states soon, but is currently serving patients in the following states:

• Alabama
• California
• Colorado
• Connecticut
• Delaware
• Florida
• Georgia
• Illinois
• Iowa
• Kansas
• Kentucky
• Maine
• Maryland
• Michigan
• Mississippi
• Missouri
• Montana
• Nebraska
• New Mexico
• New York
• North Carolina
• Ohio
• Pennsylvania
• Tennessee
• Texas
• Utah
• Virginia
• Washington
• Wisconsin
• Wyoming

How much does Folx HRT cost?

There are two main hormone therapy plans that you can subscribe to with Folx, and a variety of add-on products available.

Folx Estrogen plan

For those just starting out on estrogen, those who have been on it for under a year, and those who have returned to it after a six-month or more lapse, the New Start/Restart Plan is $119 per month. This includes medications, clinical check-ins, quarterly labs to track your hormone levels, access to a clinical care team, and automated refills and deliveries. You’ll need to be on this plan for one year before being able to move to the Maintenance Plan.

The Maintenance Plan costs $59 per month. It includes your medication, annual online clinical check-ins, annual labs, unlimited messaging with your care team, and automated medication refills and delivery.

Folx Testosterone plan

For those just starting out on testosterone, those who have been on it for under a year, or those who have returned to it after a six-month or more lapse, the New Start/Restart Plan is $139 per month. This includes medications, clinical check-ins, quarterly labs to track your levels, access to a clinical care team, and automated refills and deliveries. You’ll need to be on this plan for one year before being able to move to the Maintenance Plan.

The Maintenance Plan costs $89 per month. It includes your medication, annual clinical check-in’s online, annual labs, messaging with your team, and automated refills and delivery.

Outside of your plan, you can add on additional medications that vary in type and price. If you’re curious, check out their site for more details.

Does Folx accept health insurance?

Folx does not accept insurance. However, if you are on an insurance plan that includes an HSA or FSA, that can be used to pay for Folx. The platform does not accept Medicaid or Medicare (though they may be used to cover the cost of your prescriptions at a pharmacy). According to their website, they are working towards being able to offer financial support, but they do not currently do so.

Plume vs Folx: Which online trans healthcare service is better?