Plume: legitimate or a scam? A full review and rating of the service. has gotten a lot of attention and is increasingly popular due to the convenience of telehealth – especially during the 2020 Pandemic. Around the web you’ll find a lot of questions about the legitimacy, limits, and process. Much of this is covered on the Plume website, but I’ll be coming at this review with first hand experience.


In no way does this article or the author in any official or unofficial capacity represent Plume or its doctors and services directly. This review and rating of Plume in this article is solely based upon the author’s first hand experiences. Your mileage may vary and things may change from the time of this writing.

1. Legitimacy: 5/5

Yes. Plume is a legitimate telehealth option. The doctors are real, the labs are real, and the prescriptions are real. I would give the Legitimacy of Plume a 5/5 rating. You will get real prescriptions, real labs, and leisurely access to your Doctor through the mobile app.

2. Technology: 3/5

All communication is intended to be done through a “secure” mobile app “Spruce”. This app works, sorta. The editor is particular and glitchy, but it works. Unfortunately you don’t have direct email or phone access to your doctor, but the doctors on Plume are usually responsive within a business day if not also on the weekends. The app itself did not work well enough for our initial video call, so we switched to a traditional phone call. I would give Plume’s Technology a 3/5 rating.

3. Pricing: 3/5

Plume is $99 per month for access to labs, doctors, and prescriptions; however, that $99 does not include the cost of prescriptions. Depending on the type of prescription, ongoing prescription costs can be quite low. Injections and patches are among the more expensive types of prescriptions. For ~$1,200 per year, Plume is very convenient; however, may be out of reach for many who can barely afford HRT at all.

There seems to be a misconception that HRT prescriptions are cost prohibitive (ie you need insurance to pay for them). Oral Estradiol for example can be less than $10 per month, and highly effective. Plume is affordable for many people, but too expensive for many as well, so I give it a 3/5 rating. If Plume beat the DIY route in cost, I think it would be a more viable option for the trans community overall.

4. Individualized Care: 2/5

Plume doctors will prescribe anything that is outlined on the website, and nothing else:

This is where I start to have a lot of mixed feelings. If you respond atypically to any of the provided treatment options, your choices quickly become limited. For example they support a total of 3 anti-androgens and for me personally, Finasteride/Dutasteride are off the table (they operate very similarly as medications also, so really there are only 2 anti-androgen choices), leaving only Spironolactone, which has little consensus in studies regarding efficacy and many side effects; some of which may even limit transition potential, such as breast development []. Plume is remarkably inflexible when it comes to individualized care, sparing zero exceptions to the general guidelines.

Personally I am left feeling largely unheard. I appreciate the focus on safety, but the field of transgender medicine is constantly evolving and people respond diversely to medications; Plume seems to trail behind with selective allegiance to only certain literatures while ignoring others, or accepting certain risks but not others. I would give Plume’s focus on Individualized Care a 2/5 rating since it probably works well for some people, but special consideration is nil.

5. Guidance: 3/5

With Plume, you’d better do a lot of reading and figure out your drug selections solo. The doctors do not seem to give 2 cents on anything in regards to what will work “best”. A good example is IM (Intramuscular Injection) Estradiol Valerate vs. Estradiol Cypionate. The only feedback I had for that decision was price point. As it turns out, after a lot of research EC has a much flatter curve of absorption which matters A LOT with Plume for Labs. I give Plume’s Guidance a 3/5 rating because they will provide very rudimentary advice, but it lacks context and is short sighted. Ultimately you have to research everything to make informed decisions and once you do that, you’ll find the supported medication options very limiting.

6. Labs: 1/5

The only lab support Plume has is Quest Diagnostics, which in my case was over 33 miles away for the closest location. I paid out of pocket to use LabCorp which was 3 miles away. In my case I have more money than time, so this was an easy choice. They only test basic liver and estrogen levels (for transfeminine). DHT is probably important periodically to know for example, and is spared no consideration. Check out our Labs category for more laboratory information.

The real issue with the Plume labs isn’t in the tests or locations – it’s that they measure your peak absorption curve for safety. In the case of Estradiol Valerate that peak is much higher than Estradiol Cypionate. Guess what happens when your Estradiol level is too high? They smash your prescription back down to introduction levels, which leads to crushing depression and dysphoria.

If I had been dosing with Estradiol Cypionate instead, I might have maintained the exact same injection schedule and dose merely due to the absorption curve difference. This is a total lack of critical thinking in my opinion. Between the poor location density of Quest Diagnostics, limited testing, and a glaring lack of consideration for hormone absorption curves, I give Plume a 1/5 rating on Labs.

[reference: Estradiol Benzoate/Valerate/Cypionate hormone absorption curves]

7. Acceptance: 5/5

Plume is essentially an informed consent service. They will accept anyone who wants to transition with hormones, who gives no indication of a major physical/mental health issue (presumably). After a quick video/phone interview, you will get a prescription. Obviously I am not representing Plume with this statement. You can find more details here:

Overall Rating: 3/5

Plume is overall worth a look and I would definitely recommend it as a starting point for people who don’t know if they are “really” trans, can’t get a prescription, or are facing other hurdles. You don’t even need to identify as “trans” to get a prescription (see #7 Acceptance).

That said, If you are atypical in physiology, have special prescription needs, or want to be in charge of your own treatment; Plume seems to fall flat and is entirely uncompromising.

I believe Plume tries hard to legitimize trans treatments and actively avoids certain medication risks; unfortunately with that aim comes a factory type approach where everyone fits into the same box for hormone levels and medication options… natural human hormone levels vary dramatically in multiples, and different people need different medication options due to adverse reactions or contraindications with existing medications.

4 thoughts on “Plume: legitimate or a scam? A full review and rating of the service.

  1. Thank you for taking the time to write your review. My worst fears about it were confirmed, I was concerned it wouldn’t be anything like going to a doctor in person, wouldn’t be as personalized, and that checks out. The article revealed some things I didn’t even expect to happen. All that is very unfortunate, I’ll have to go to a real doctor for that. Maybe it’s for the best.

  2. Agreed, with pretty much all of this. I practice trans medicine and see their ads often on FB and have seen the comments underneath them, as well as reviews from other sites. The inflexibility they have with medication regimens is strange. And while I could argue the point about lab variety being simply that a lot of the more advanced labs are only necessary when transitional issues are encountered, or that specialty labs like DHT, Estrone, Estrone Sulfate, and 3-Andro would make the self-pay lab cost waaaaay less affordable, I’m not going to. And the reason is that, while those things I mentioned are true, so is the inflexibility I see mentioned by people quite often. Which leads me to believe that their reason for not considering these is more due to a lack of expertise in this field, or maybe just a desire to stick to the basic easy methods of trans HRT. Basic trans medicine is insanely easy to practice. But to truly specialize in it requires more than just surface knowledge of WPATH and the other established guidelines, or the not so established ones in the case of Dr Powers *head tilt and smile*. Not saying I’m perfect in my practice either. I’ve adjusted and adapted how I practice over the last several years based off of my patients’ responses and have rolled with the research as it comes available. Trans people deserve so much better than the scraps of medicine that get doled out to them. Sigh.

  3. I have used Plume for over two years and initially, I had nothing but good things to say about the4 service. Sadly, things have deteriorated significantly over the past six months. My issues began when my estradiol levels plummeted by 56% over a period of the six months prior (approximately a year ago.) I had to be pretty aggressive to convince my doctor to increase my dosage and add progesterone to my regimen. My next lab test had a HUGE increase–from 55 to 130. the next lab test showed a decrease to 106, followed by my latest decrease to 84. That’s a drop of 36% between August 2022 and January 2023. Additionally, my T levels rose from 17 to 21 over the same period. What’s wore is that I had been noticing a significantly slower response time from my doctor–from about 5 days to three weeks and this time I had to contact the lab directly to obtain my results. Compounding this, the lab repr4esentaative told me that Plume has had my results since Jan 10. The actual timeline is as follows: tests on Jan 6, results sent to Plume on Jan 10, my first contact with Plume r4egarding this on Jan 19 (Plume said they would get back to me in1-2 days), and my contact with the lab on Jan 23. I notified Plume and sent them copies of my results and requested follow up with my physician as I am concerned. I also requested that a customer care associate contact me to discuss my issues. I provided my phone number and reminded them of my email. They have not responded. I find this annoying and unprofessional.

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