This company is helping Missourians prepare for looming restrictions on trans healthcare

Since mid-April, transgender people in Missouri have known that it could soon be much harder for them to get gender-affirming care in the state.



On April 13, Missouri Attorney General Andrew Bailey announced an emergency rule that puts big limits on hormone therapy for both adults and children, and was set to take effect Thursday, though a judge temporarily blocked the measure Wednesday in response to lawsuits from advocacy groups.



The rule significantly increases the hurdles for anyone seeking hormone replacement therapy and other care, making it illegal to provide gender-affirming health care to anyone without three consecutive years of “medically documented, long-lasting persistent and intense patterns of gender dysphoria.” It also ruling requires patients to go through eighteen months of therapy before receiving care.



In a statement issued shortly after the rule was announced, Sarah Ellis, president of LGBT advocacy organization GLAAD, called the effort “an unprecedented attempt to restrict an entire group of people from being able to make informed medical decisions in order to live and thrive” that “includes outright lies and falsehoods about best practice care supported by every major medical association.”



In response to the rule, Plume—a telehealth service focused on the trans and nonbinary community, that has operated in Missouri since 2020—is offering free consultations to people in Missouri as well as free access to peer support groups and free lab work as needed.



Dr. Jerrica Kirkley



“We want to make sure folks can have access to medication and we want to offer them a buffer to ensure they have safe access to lifesaving gender-affirming care,” says Dr. Jerrica Kirkley, cofounder and medical director at Plume. The initial consult involves developing a long-term treatment plan, as well as ordering lab work.



Kirkley said Plume is also providing medication to last as long as possible, which could be up to 90 days depending on the medication. Plume’s website advises patients to ask about ways to properly store medication to maximize the number of doses, as well as ways to decrease doses based on the individual’s hormone levels in order to stretch out medication.



Since April 13, Kirkley says Plume has treated more than 15 times as many patients in Missouri than it had in the preceding three months in the state, adding that staff have been working over time to meet demand.



If people aren’t able to access care in Missouri, that may mean looking for care out of state, which is not an option for everyone depending on insurance coverage or their ability to move. It could also mean turning to the black and grey markets—if the stockpiles people are amassing run out—or leaving the state entirely. Kirkley says the measure “is taking away care and driving folks to unsafe options. It’s important to make sure we have safe avenues for care.” She noted patients are worrying about everything from their care to their every day safety.



Even as she has rallied her company to help mitigate the immediate effects of the rule, Kirkley is already considering the long-term way it will affect gender-affirming care in the state by making it even more scarce. Currently, few Missouri clinics have the cultural and clinical expertise to provide care, and the ones that do are often in major cities, with waiting lists that can be up to eighteen months long. It could also have a chilling effect on providers, with penalties and requirements making them hesitant to provide services to patients.



In turn, trans and nonbinary patients may be more hesitant to seek care if they fear discrimination. According to a 2020 study, 30% of trans patients have postponed or avoided medical treatment due to discrimination, and a third have found they need to educate providers about their gender identity to receive appropriate health care.



Missouri is also not the only state taking steps to make it harder to get gender-affirming care—or curtail it entirely. According to the ACLU, there are 122 LGBTQ healthcare rights in the US at the moment. The Missouri rule comes in the wake of North Dakota, Indiana and Idaho banning gender-affirming care for most minors. Meanwhile, Oklahoma is in the midst of considering a bill that makes making providing transition-related care a felony, and prohibits insurance from covering it.



With the ruling still in limbo as lawsuits proceed, Kirkley says Plume will shape it’s response accordingly, but its focus is on the torrent of patients looking to shore up any potential gaps in treatment to prepare for the rule taking effect.



Though a note on its website says appointments were booked up by April 24, Plume is working to open more slots to keep offering appointments (and directing patients to other local organizations with openings). “We’re going to continue providing as much care in Missouri to the extent it’s legally possible,” Kirkley says.