Recently, I was watching a makeup tutorial by one of my favorite artists on YouTube when I received an advertisement that set off internal warning bells. The ad was from a new subscription service called Plume. In it, an obviously trans woman speaks lovingly about a new way to get started on your smooth transition into another gender: a $99-a-month subscription service that serves as a one-stop shop for all of your transitioning needs.
According to the Plume website, benefits of your membership include digital appointments with a health-care provider, prescriptions for “gender-affirming medications,” lab work, live injection support, a letter to facilitate name changes, and a medical letter of support for surgery from a doctor. And they promise not to misgender you or use your old pronouns.
The surgery support letter has a $150 fee, and you don’t need a Plume membership to receive one. The only requirements to receive this letter are being at least 18 years old (which I question how they enforce), the fee, and a digital appointment with the doctor writing the letter. Plume even includes a list of recommended surgeons. The website provides the caveat that they are unable to provide a “behavioral health letter of support” from a therapist.
I am fresh out of my undergraduate career, and while my Bachelor of Science degree in Psychology makes me no expert, I do recall from my courses that “gender dysphoria” is still a recognized disorder in the most recent version of the Diagnostic Statistical Manual. So it’s surprising that Plume offers no mental health services or consultations in their subscription plan, especially considering the high rates of mental health issues in the trans community. A 2020 Dutch study, for example, indicated that the suicide death risk among the trans community is much higher than that of the general population. It also found that suicides among the transgender people studied occurred during all stages of transition and all stages of care. Psychological comorbidities were not studied, so there is no true way to know the cause of the suicides, but all explanations must be considered.
Members of the trans community often claim that bullying and lack of acceptance are the only explanations for the high rates of suicide among their peers. This assertion completely discounts the existence of gender dysphoria and other psychological maladies, including PTSD from past sexual assault and other common issues among the community like alcoholism.
Yet some are more honest about the backgrounds and past traumas of some transgender people. The Office for Victims of Crime states, “Studies have shown that … transgender people are more likely to be sexually assaulted in childhood than heterosexual or non-transgender children.” They add that instances of sexual assault in childhood make it difficult for some trans sexual assault survivors to determine if their past abuse is causing their dysphoria or not. Most of the trans community resents this idea and the stories of sexually assaulted detransitioners because they think these invalidate their belief that they were born in the wrong body.
This “born this way” thinking can be harmful, especially for young and impressionable sexual assault survivors who think the solution to not getting harmed sexually in the future is to switch genders (most commonly from female to male). Indeed, in a study of prisoners, trans men who were formerly women were sexually assaulted at much lower rates than trans women, proving that women, whether biological or not, are at a higher risk of being sexually assaulted.
Plume addresses these concerns nowhere on its website, even acknowledging that the company cannot provide a behavioral health recommendation for surgery. For such a dramatic change — removing genitals and secondary sex characteristics is no small decision — you would think that there would be some sort of pre-surgery counseling to address causes of the patient’s gender dysphoria. This anti-therapy sentiment seems to be common among Plume’s customers. Look no further than this video, where a transgender woman derides the therapy requirement necessary for hormone replacement therapy. The individual then promptly injects himself with his first dose of estrogen provided by Plume. This could help explain why Plume may avoid therapy talk altogether.
Even if Plume subscribers don’t opt for the surgery route, the hormone medications provided by the service to “live your authentic life” can have irreversible effects. Many detransitioners (or detrans) express disappointment over these lingering effects. Elle, a popular detrans YouTuber, shared in a vulnerable video explaining her detransition that while many effects of her hormone therapy did subside, her voice remained permanently deep and her body hair still grows at unmanageable rates. Elle also said her LGBT therapist did not question her motives for transitioning but instead served as her advocate to fast-track her into hormone replacement therapy.
Other detransitioners have described feeling like parts of themselves were missing after top and bottom surgeries. A recent 60 Minutes documentary provides an excellent look into the lives of these detransitioners after surgery. Many of them describe how they were able to receive medication as a minor and schedule a top or bottom surgery within a year.
Plume boasts that after your appointment, you’ll be able to pick up your hormone prescription the same day. The current wait time for an appointment? Two weeks. With $99, an app, and two weeks, you or I could be on testosterone or estrogen. The same expediency can not be said of any other drug of this severity, and for good reason. Services such as Plume are part of a disturbing new trend that fails to address real mental health concerns in the trans community.
If anyone should be handling a medical procedure as serious as a gender transition, it should not be an activist-doctor. It should be a primary care physician.