The newly launched platform has quickly become a go-to for queer healthcare with online consultations from medical experts in the community and treatments – from hormones to PrEP – delivered straight to your door
We’re 12 months deep in the coronavirus pandemic and healthcare infrastructures around the world are strained to their limits in providing adequate care, oftentimes having to choose who to give care to. Transgender and non-binary people have been one of the hardest hit, already suffering from biases and discrimination. In June last year, the US Department of Health and Human Services (HHS) finalised a rule that retracted Obama’s definition of sex discrimination in the Affordable Care Act (ACA) from gender-inclusive to “‘sex’ as male or female and as determined by biology.”
Mara Keisling, executive director of the National Centre for Transgender Equality, criticised the rule for being “hateful and cruel” and that it would further prevent transgender people from living their most authentic lives. At the same time in Boston, MA, A.G. Breitenstein was busy creating a solution: FOLX Health.
FOLX Health, a US-based company launched during the pandemic, is the first major LGBTQ+ digital healthcare company upgrading the queer and trans health and wellness space. Its completely online model allows trans and non-binary individuals to bring the process of hormone replacement therapy straight to their homes. The entire process takes place wherever the patient is comfortable, from the initial medical intake to the visit with a physician. The platform currently offers HRT for both testosterone and estrogen and will release sexual health, skin and hair, and family planning services in the future.
Breitenstein, CEO and founder of FOLX, created the company after more than two decades of working in traditional healthcare spaces in the Boston area. The first job she had after graduating from the University of Connecticut School of law in the 90s was in a queer and trans-led organisation that advocated for homeless youth. She went on to found the Health Law Institute that focused on HIV prevention, then Humedica, a big-data analytics company specialised in healthcare, and most recently Optum Ventures a VC firm investing in health-tech companies.
A month later in July, Dr Kameryn Lee was reading the clinical boards for the World Professional Association of Transgender Healthcare (WPATH) and saw a recruiting ad for FOLX Health. Described as queer and transgender healthcare, Dr Lee knew immediately that this was the exact workplace she had been looking for all her life.
Dr Lee met a trans doctor for the first time during her obstetrics and gynaecology residency in the early 2000s. The first Black doctor she met was a decade earlier when she left North Carolina and attended MIT in Boston for her undergraduate degree. She had never intended on being a doctor and chose MIT because they’re the best engineering school in the world, but after shadowing the Black surgeon in Boston, her life path took a different direction.
According to the 2019 US Census, 13 per cent of the population is Black but only 5 per cent of all doctors are Black according to the American Medical Association. Within that Venn diagram is another smaller circle of Black transgender doctors. The UCLA Williams Institute, a public policy and gender identity law research institute, reports that 1.4 million people in the US identify as transgender. “When you do all the math, it’s way less than a hundred of us,” Dr Lee says. She’s never met a colleague that looks like her, let alone shared the same lived experiences in her entire decades-long medical career.
Health tech has been one of the slower industries to catch the startup bug, but in recent years and especially during this pandemic, more companies are coming up. Telehealth and telemedicine searches skyrocketed in 2020 and reached peak popularity in March according to Google Trends. In a world where movement is restricted, bringing medical and health services into the home was a no-brainer. Capsule, a prescription delivery company, got 1,700 reviews from March 9 to March 12 last year as more people desired a contactless service for their mediations. Plume is another transgender HRT-focused company that launched a few months before FOLX and provides the same kind of telemedicine, prescriptions delivered straight to the patient‘s door, and all online communications.
While most of us have Zoom fatigue at this point, 12 months since we started to quarantine and work from home, these digital experiences make all the difference for queer and trans folks seeking safe spaces for care. Rather than a typical doctor‘s office that‘s sterile and filled with power hierarchies, being able to video chat a healthcare provider from home puts the patient in control of the physical and emotional interaction, says Breitenstein. Putting control back into the consumer‘s hands is the most core tenet of direct-to-consumer businesses. No middle people; just the doctor and the patient. “Healthcare was the last remaining individual where we weren‘t centring individuals and personalising their interactions,” says Breitenstein.
The very same day Dr Lee saw the posting for FOLX, she applied and was immediately contacted by their team. After a round of interviews and meeting the rest of the team, she joined as clinical director and appears often on the brand‘s Instagram Live videos discussing topics like taking up space as a queer and trans person of colour or the COVID-19 vaccine. “I have something unique to offer as a Black trans person. A lot of the people doing trans care aren’t trans people, and almost none of them are Black,” Dr Lee says.
”Rather than a typical doctor‘s office that‘s sterile and filled with power hierarchies, being able to video chat a healthcare provider from home puts the patient in control of the physical and emotional interaction”
She shares how her meeting with members have been unusually authentic because she‘s able to share who she is as a person, to “have a very deep connection with them, trans person to trans person.” Compared to traditional doctor‘s appointments where the physician barely shares anything about themselves, the largest part of the visit with FOLX clinicians is talking about personal stories. One member of Dr Lee‘s is the first trans person to own a skateboarding company, another is filming a documentary about the Black trans experience. As refreshing as it is for members to finally see physicians that reflect themselves, these visits also rejuvenate the providers just as much. “They give me the light to keep pushing through the day,” Dr Lee shares.
A common theme across team members at FOLX is the ability to bring their personhood into the job. “The key to the success of our company is putting the T at the beginning of our alphabet soup,” Rocco Kayiatos, VP of marketing, explains. He‘s been on HRT for 21 years now and this firsthand experience gives him, and others on the team, “an intimate, somatic experience as patients.” Kayiatos‘s extensive experience in building community is what drew Breitenstein to hire him despite not having a traditional pedigree for someone of his title. He‘s built a career focused on community, hosting a summer camp for men of trans experience called Camp Lost Boys. He later went on to work at Buzzfeed, Spotify, and Grindr to create shareable LGBTQ+ content. When he read the job posting for his role at FOLX it was the first time his entire career made sense, he says.
Up until FOLX, Kayiatos saw many offerings for the LGBTQ+ community come and go because of the lack of support. Most people who are driven to do this kind of work for queer, trans, non-binary, or intersex folks are doing so typically in non-profit or volunteer settings, he says, and those systems are “stretched beyond capacity”. 15 of the years Kayiatos has been on HRT has been at LGBTQ+ free clinics that are overbooked and difficult to get appointments at, creating gaps in care, even his own. FOLX having venture-capital funding is the first time that there is financial support to build something sustainable and long-lasting.
The other benefit of community-specific healthcare is that information becomes more accessible. The US and many other countries’ healthcare systems are challenged by a phenomenon known as asymmetric information: a dramatic difference in health and medical education between provider and patient creates knowledge gaps, and this translates into patient frustration, over- and under-treatment, and insufficient care.
FOLX addresses this gap in the market through its Library, a clinician-vetted blog for all things queer health. Articles include guides on self-injecting at home, microdosing and low-dose HRT for non-binary and genderqueer folks, and the basic physical changes one can expect when going on hormones (testosterone or estrogen). The team has collected, organised, and centralised trans and queer-specific health information that’s existed across Reddit threads, individual blogs, and on the websites of LGBTQ+ centres.
Although FOLX is only available in 12 states in the US at the time – California, Texas, Florida, and New York are its biggest states – they plan on opening nationwide soon, and eventually worldwide. In the meantime, the Library acts as the universal connector for people in unopened states, the UK, or anywhere on the globe to access medically-vetted trans-first health information without having to DIY their solutions.
In only two months, the brand has amassed over 14k followers on Instagram, and its content is frequently shared, says Kayiatos. FOLX partners with LGBTQ+ influencers like Laith Ashley, Isis King, and Brian Michael Smith, and has created a community advisory board, another checkpoint in ensuring the brand is held accountable by the community.
Ultimately, Rocco dreams of FOLX becoming bigger than a company that just provides medications and clinical visits. They are in the business of taking care of people, he says, and that means taking care of the community, specifically Black trans women. “We’re in this unique position to communicate the value of trans and queer bodies,” Kayiatos says, and to that end, they’ve created the HRT Care Fund. Partnering with the Trans Lifeline, a non-profit offering support to trans people in crisis, the scholarship program aims to redistribute financial support and provide up to a year of HRT care for trans and non-binary people.
In the backdrop of the global Black Lives Matter movement, this fund provides a clear way for brands to walk the walk, after posting their black squares of solidarity 10 months ago. Rather than the same $20 being laterally circulated from one individual to another in the community, bigger companies who use LGBTQ+ people in their Pride campaigns can donate a bigger sum of money towards more sustainable care.
“FOLX Health’s queer liberation of healthcare is not only going to transform LGBTQ+ resources but will impact that of women, children, and folks of colour. What’s more, is that the younger queer and trans generation will be able to see themselves reflected in healthcare and professional environments”
Like any startup, FOLX is not without its own set of issues – ”creative chaos”, Breitenstein confesses – but the difference is that the team is of the disenfranchised community they’re serving. They know how important and necessary this type of service is after spending years being frustrated with a system that casts queer and trans people aside. This queer liberation of healthcare is not only going to transform LGBTQ+ resources but will impact that of women, children, and folks of colour. What’s more, is that the younger queer and trans generation will be able to see themselves reflected in healthcare and professional environments. Dr Lee and Kayiatos are a testament that nothing is impossible; yes, it’s a lot more challenging for a person of colour or LGBTQ+ identity, but Dr Lee says that there’s no one stopping you.
At the end of the day, she’s not here to make a tonne of money from a startup opportunity. “If I can be the person that someone can see and say, ’If Dr Lee was able to do it, so can I’, then that means I’ve done my job,” she says. After staying in the shadows for a long time, Dr Lee is ready to step into the spotlight.