So, even though I used Plume for a year and a half, I cancelled my subscription.

There are two big things I hate about this new trend of trans-centered care. I hate that they practice “concierge medicine”, meaning instead of working with insurance companies, you have to pay out of pocket for their services. Most trans people live at or below the poverty line, so $99 per month is barely affordable for most of us. (Their subscription usually does covers getting labs done at a local lab center.) However, it doesn’t cover the prescription, which of course they would be happy to sell you, but again even if your insurance covered sex change change therapies, they wouldn’t take it. (You could try for an out-of-network reimbursement; I’m not sure how that’d work as my insurance does cover HRT for trans people, and I went to a local pharmacy that accepted my coverage.) They “claim” being concierge makes them more ”innovative”—bollocks; it just means they don’t want to deal with insurances.

I also am not a big fan of “informed consent”—where you read a brief summery of information about hormone therapy works, sign off a form or two, and then you get your prescription within a few days. Call me a “transmedicalist” or “gaitkeeper” all you want, but I think a few visits with your medical provider are necessary before they issue hormones, if the idea of seeing a therapist for several months before taking HRT seems “too long”. This is some of the most powerful stuff anyone can take, and while many of the side effects can be reversible, not everything is. There are ways to get insurance to cover medical transitions, if your insurance excludes trans-affirming care. Not everyone is sure about whether they are trans, because they don’t need a sex change; there are drag performers out there who will claim they’re “trans” to get treatments to look more “fishy” (or, “realistic” when performing drag). It’s always a good idea to medically screen to make sure there isn’t something else that may be confused for being trans; there are trans people who don’t realize they may have a medical contraindication that may preclude them from taking HRT. And if you are seriously dysphoric or depressed, that is not the best mindset one should be in to get hormones.

I know the majority of the trans community disagrees with me, but I think this push to “liberalize” our medical access is a big contributor to why Republicans, conservatives, and reactionaries in general are pushing back and trying to legally regress our access to sex reassignment therapies.

Another big reason I signed off is because the center I am going to just doesn’t help trans people, but they are a comprehensive health clinic, close to home, who take my insurance. It makes no financial sense to continue paying for a service that’s for post-op care, that’s solely about keeping my HRT refills active, when I am seeing a provider now who can prescribe testosterone while taking my insurance.

If we are going to argue for universal healthcare, we need to also argue that all medical services and providers must take that insurance, and outright ban the concept of “concierge medicine”. It discriminates against the poor and working classes; the model tells doctors it’s all about a wealthy lifestyle, rather than being a civil servant to care for the people. These new telemedicine services would truly be a lifeline to the trans community, if they took our goddamn insurance.

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