When Matthew Wetschler first approached Jerrica Kirkley, he spoke in a foreign tongue. The two were medical students at the University of North Carolina. Wetschler heard secondhand that Kirkley spoke Spanish and, after pathology class one day, approached her, excitedly yammering along in his second language. Before long, the two bonded over their love for athletics — Wetschler is a nationally ranked rower, Kirkley owned a bike shop for a few years — and the rest, as they say, is history.
In June, the two doctors founded Plume, a Denver startup that offers remote hormone replacement therapy consultations and prescriptions to the growing but underserved transgender population. The startup has raised eyebrows among a few peers in the profession, which speaks directly to the company’s business case and the societal need.
“Historically, medicine has been a one-size-fits-all solution,” Wetschler told Built In. “As our society becomes more diverse, that’s working for fewer and fewer communities. Our thesis is that medicine can, and sometimes should, be organized around people’s identities and experiences.”
Just four months since its launch, the company has scaled to 12 states. The company credits its early success to its team.
Building the appropriate tech, business processes and healthcare delivery model depended on Plume’s staff understanding and representing the individuals they aimed to serve, Kirkley said. The two also felt strongly that staffing the company with diverse individuals was the right thing to do. Today, nearly 80 percent of Plume’s clinical team identifies as trans, and more than half of the company’s business side is comprised of transgender individuals. The company credits its inclusive design and work culture to recruiting the right team for the startup.
“Discrimination won’t go away just because we decide that it’s become inconvenient or we don’t want it to exist anymore. It requires more than that,” Kirkley told Built In. “Frankly, you have to pay for it with either money or time. If you’re not, I don’t think you have a realistic expectation of what it takes to create a diverse workforce.”
How to Explain Trans Services to a Sea of White Men
The business case for Plume’s technology becomes clear when you look at the statistics.
Of the 1.4 million adults in the United States who identify as transgender, a third avoid seeking healthcare out of fear of discrimination. Many also lack access to appropriate clinics, since the few doctors who are trained in hormone replacement therapy are often centralized in major cities with long waiting lists. For trans people who do enter a doctor’s office, more than 20 percent are denied care or harassed. This leaves the majority of transgender people buying testosterone, estrogen and testosterone blockers from disreputable sources overseas or off the streets.
Kirkley and Wetschler knew they had a market. The duo also knew they had found a niche: custom telehealth services exist for women, those suffering from diabetes, individuals struggling with depression and more, but Plume represents the first virtual healthcare service for those who specifically identify as trans.
But as the two prepared their pitch, Kirkley felt like the cards were stacked against the startup. As a single mother and a trans woman, she knew she would have to explain the necessity of Plume to a sea of white, cisgender men. She worried about being forced to answer inappropriate questions unrelated to the business, like if she had “fully transitioned” or undergone surgery.
“There’s always this concern about what questions will be asked,” Kirkley said. “Are they really appropriate to what’s going on? Are they focused on the task at hand, which is evaluating this business?”
But when the Plume founders entered board rooms they received a respectful, and excited, audience, she said. The startup was funded in under six weeks by General Catalyst, Slow Ventures and Springbank Collective, and its nearly $3 million seed round was oversubscribed. Now, Kirkley said it’s not uncommon that investors will reach out to tell her that, actually, they have a family member who identifies as trans.
“All of a sudden they realize they have just maybe one degree of separation from a trans person,” Kirkley said. “They’re like, ‘Trans people are everywhere.’”
Finding and Hiring the Right People
Plume’s success depended on its staff, and a successful staff depended on a successful recruitment strategy.
But Kirkley and Wetschler didn’t want to hire a single token, transgender individual, and they knew they weren’t likely to find who they were looking for on AngelList. The company tapped their personal and professional networks, like Out in Tech, looking for transgender individuals with the right qualifications to staff Plume.
“Without intention, it’s very easy to end up with a fairly homogenous organization like 20 to 30 people in,” Wetschler said. “Then, if at that point you’re trying to attract more diverse candidates, and they don’t see people like themselves, I think it’s not unrealistic to ask, ‘Is it really a safe space?’”
After hiring one transgender individual, they said it was easier to hire the next. Recruiting diverse candidates is no longer a problem, Wetschler said. He added that it was key the startup intentionally staff folks who were representative of the client base early, even if it meant moving at a slower pace than investors would have liked.
“Despite the pressure to scale, start growing yesterday, we took the time and pumped the brakes and said, ‘Hiring the right people that represent our values is non-negotiable,’” Wetschler said. “We took the heat for that.”
What Startups Can Learn From Plume’s Design
Plume has designed every element of its platform with the transgender community top of mind.
When signing up for Plume, individuals are asked to use their chosen name, rather than their legal name, which can often be difficult to change for transgender folks. They are also asked their pronoun, so no one is accidentally misgendered, and their initial sign-up does not ask individuals to name their gender. Plume has also built its HIPPA-compliant system with a strong focus on security so it protects user data.
“If you look at every point of interaction with different industries, whether that’s the healthcare industry, the banking industry, there’s just so many places that could use improvement on their processes,” Kirkley said.
‘Silence Can Actually Be Quite Harmful’
In addition to intentional design, the two focus on creating an environment that feels safe for their transgender staff. The company aims to remain cognizant that the last national survey of the trans community was conducted in 2015, and that changing attitudes likely mean there are more trans-identified people out there than the 1.4 million counted. Kirkley said it’s important to let people present themselves however they feel comfortable.
“I think there can be a lot of pressure to perhaps not be open in your work environment and out,” Kirkley said. “There’s potentially a misunderstanding or misconception there. Actually, there are many trans people within the tech industry.”
Plume views sensitivity, bias and anti-oppression trainings as just as essential to the structure of its business as respecting HIPPA guidelines. Wetschler said bringing in someone outside of the organization to discuss these topics helps.
Now, when events like the Trump administration’s June announcement that medical providers can deny services to trans individuals with federal consent, Wetschler said he understands how important it is for him — as the white, straight, cisgender co-founder of the company — to speak up and recognize that different individuals will have different emotional experiences based on what’s going on in the news.
“People from different identities, different backgrounds experience the world in a different way,” Wetschler said. “I think it’s very important for leadership to overtly state that. I think silence can actually be quite harmful, especially if you’re trying to create space for diverse communities.”
