Trans telehealth providers of gender-affirming care, like Folx and Plume, claim to be building the community. But are they?

Not every doctor’s office runs an Instagram account that posts tips about how to approach sex with trans people alongside updates about which insurance it accepts. Indeed, trans people’s status as a convenient political bludgeon has made an already precarious path to health care even more treacherous. Jerrica Kirkley, Plume’s co-founder and chief medical officer, told me that the startup’s “goal is to transform health care for every trans life.” Kirkley says she initially tried to open a community health center in Denver for trans patients but was forced to take a different route because of red tape. Alejandra Caraballo, a clinical instructor at Harvard Law School’s Cyberlaw Clinic and a former staff attorney at the Transgender Legal Defense & Education Fund, told me, “In some ways, has been a critical lifeline for a lot of people who can’t access gender-affirming care in other contexts, particularly rural trans patients.” It’s an appealing escape hatch, but one operable only by those who can afford it. And by segregating trans health care into a concierge service, trans telehealth emboldens the biggest assault on access of all: the project of undermining gender-affirming care’s legitimacy and necessity.