(TNS) — When Aydian Dowling looked in the mirror as a teenager, he didn’t relate to who he saw. He dreaded taking his high school graduation photo because he knew he was a different person. When thinking about the future, he couldn’t picture himself as an adult based on the way he looked then. And it was painful.

Dowling came out as a trans man in February of 2009 and tried to live a life without hormones for about nine months. He told people his pronouns and his name, but that wasn’t enough, he said.

“I still didn’t feel like myself,” Dowling said. “I felt closer, but I just was like dreaming of a beard, and dreaming of a more masculinized body.”

He started hormone replacement therapy, HRT, later that year and has been continuing that medical treatment for 10 years while living in four different states. HRT is when doctors prescribe medications, most commonly testosterone or estrogen, to transgender patients to affirm their gender.

“I don’t even want to paint the trans narrative as being like always being depressed or always being suicidal, but I mean those are real things that really happened to me,” Dowling said. “I don’t think I honestly would be conducting this interview with you if I hadn’t found hormone replacement therapy because it truly alleviated my dysphoria, which was something I suffered with every single day of my life.”

Now, at 32, Dowling picks up his phone to direct message or video chat with his doctor, who is also transgender, through an app created by two University of North Carolina-Chapel Hill alumni.

“It just feels more comfortable talking to my doctor,” Dowling said. “I’m communicating with them in the same way I communicate with my friends.”

Accessible Health Care for Transgender Community

Plume is the first health technology company dedicated to the trans community, co-founder and CEO Dr. Matthew Wetschler said.

“We provide immediate access to gender-affirming hormone therapy through the convenience of a smartphone,” Wetschler said.

Wetschler, 40, lives in Asheville and graduated from the UNC School of Medicine and Gillings School of Public Health.

He said it’s safe, convenient and more accessible than most options in a brick and mortar setting. The doctors do medical examinations and provide care, including labs, for individuals to consider, start or continue hormone replacement therapy.

“So to bring them physically and emotionally in a line with how they identify,” said Dr. Jerrica Kirkley, co-founder and chief medical officer at Plume. Kirkley, 36, lives in Denver, but met Wetschler while in medical school at UNC.

She and Wetschler started the company in Colorado with their own money and a desire to improve the health care options for the transgender community.

They, along with Soltan Bryce, are growing the company, which is now available in 11 states and expanding. Bryce, 30, is also a UNC graduate and Morehead-Cain Scholar who’s now studying at Harvard Business School,

“This is work that comes from the heart,” Bryce said. “This is work that comes from immediate and intimate experience with the trans journey, especially seeking gender-affirming care.”

Plume offers patients a full clinical staff that is almost entirely trans, which is possible by using telemedicine to source providers from all over the country. They also provide letters of support, which are necessary to pursue gender-affirming surgery, and connect patients to resources for behavioral health and social support in their local community. Patients can communicate directly with their doctor via text or a video chat.

A Plume membership costs $99 per month and does not require health insurance or accept health insurance for monthly fees. Plume has a “pay it forward” program to help alleviate the costs for some patients who can’t afford care.

For most trans people who do hormone replacement therapy it’s a lifelong journey. Moving to a new state, changing jobs or losing insurance coverage can create tension around how to continue treatment. And while there are some quality LGBTQ+ specific clinics, they aren’t on every corner of every city. Plume eliminates that reliance on location, insurance and employment for trans people to seek out and maintain gender-affirming care.

This year, Plume became available in North Carolina, which is home to nearly 45,000 trans people. With all three co-founders as UNC alumni, bringing it to North Carolina is particularly meaningful to them.

Plume is also available for people in California, Colorado, Florida, Maine, Massachusetts, Minnesota, New York, Oregon, Texas and Virginia, which represent nearly half of the trans community in the U.S. It takes patients 18 and older, some of whom are starting hormone replacement therapy in their 50s and 60s.

They hope to launch Plume in other other states and provide this health care option for the 1.4 million transgender people in the U.S.

Seeing Doctors Who Understand

Kirkley, a trans woman, grew up in Raleigh and went to N.C. State as well as UNC. She has been a primary care doctor in Colorado for the past seven years. She developed a protocol and an LGBTQ+ curriculum during her residency and incorporated that into community health care centers, free clinics and her own practice. But, she said, even at those places, which are the most accessible points of care, she was constantly running up against barriers.

“Whether that was because of geography, because of insurance issues, payment issues, just fear of discrimination of even entering into a healthcare facility,” Kirkley said. “It was hard to get folks care.”

It can also be intimidating, uncomfortable and sometimes dangerous, Wetschler said.

When transgender people go to a doctor’s office, about 25 percent face discrimination or are refused care based on their gender identity, according to Wetschler. And up to 30 percent delay care entirely out of fear of discrimination, he said. If an individual does manage to find a clinic where they’re able to see a physician, often those physicians are unfamiliar with gender-affirming hormone therapy.

When Dowling first started hormone replacement therapy, he had to take an hour and a half train ride into New York City to visit a clinic. He has had at least five different doctors while navigating his medical treatment, but had never seen one who was transgender before finding Kirkley through Plume.

“To have access to a trans person it’s like, I don’t have to come out, which is always the scariest part honestly,” Dowling said. “Because you just don’t know how a doctor is going to approach you.”

Some doctors had never seen a transgender patient and asked if a few other doctors could come in to examine him like he was a spectacle.

“It’s just really degrading,” Dowling said. “Although I am a man, I was raised and lived as a woman for 22 years. And, to have these four male doctors looking at me ... inside of me ... can be scarring for you and can really make you feel disempowered in your body.”

“And I don’t think that any person, trans or not, should ever have to feel that way,” he said.

Finding Adequate Health Care Options

In June, the Trump Administration eliminated transgender protections in the Affordable Care Act, which was inclusive of gender identity and sexual orientation for medical services.

“And with that rolling back, it does make it possible in certain states for insurance companies or individual physicians to deny coverage or care based on gender identity,” Wetschler said.

Research shows that gender-affirming hormone therapy “reduces symptoms of anxiety and depression, lowers perceived and social distress, and improves quality of life and self-esteem” in transgender children and adults.

“For me personally in my own transition, you know hormones were definitely something that made me feel so much better,” Dowling said.

“Plume has helped me directly by just allowing me to have access,” Dowling said. “Especially right now, in the middle of a pandemic, when I can’t get out to doctor’s offices and I can’t just go and try this doctor or try that doctor. And also I can’t access my community right now because I just moved here.”

Plume is also a resource for transgender individuals who aren’t sure if they want to start HRT. They do question and answer sessions with Kirkley and put out information on their website and Instagram to help people navigate the decision-making process.

Bringing Plume to North Carolina

Bryce, who grew up in Rocky Mount, would often visit family in North Carolina during the controversial House Bill 2. Also known as the “bathroom bill,” it rolled back local anti-discrimination protections for transgender people by requiring them to use bathrooms that matched their birth certificates while in government facilities, including schools.

”The legacy of a bill like that looms large for the trans community,” Bryce said. “Seeking care, just being physically themselves anywhere, is a threat and a fear.”

Bryce said the team sees North Carolina as a place where people can be celebrated and hopes this service can be part of that.

“Being able to access care through your smartphone, through the safety of your home or wherever is safe for you can be the difference between life and death,” Bryce said. “It can be the difference between living authentically.”

Improving access to health care not only changes lives in the trans community, they say it can also create social change by reducing the stigma that transgender people face.

“You can change people’s minds by changing their hearts,” Kirkley said.

©2020 The News & Observer (Raleigh, N.C.) Distributed by Tribune Content Agency, LLC.