There are no "per appointment" fees charged. Read on for how things are done.... -There is a $100 one-time admin fee due at the time you book the first appointment. This is a cost independent of appts themselves (which are covered by the monthly fee mentioned below). -Once you have booked the first appointment as mentioned above, appointments are covered by a monthly fee: $50 per month for the first 12 months, then $40 per month after that. *The monthly charges begin on the 3rd of the month following the completion of your first visit. Example: if your first appt is on Feb 6th, then first monthly charge is run on March 3rd. The monthly fee covers your appointments with us as well as any other HRT related services we perform for you, like our messaging service and any letter writing for surgeries and gender marker/name changes. It does not cover labs and medications. See that section for details on those.

No. We apologize, but we do not at this time. Our reasons for this are many, the 4 main justifications are below: 1) Most health insurance companies right now do not reliably cover gender care services. And the ones that do tend to make it so hard for the patient to qualify for the coverage that ends up being the same as if they didn't cover it anyway. 2) Insurance companies change covered benefits every single year. So while the services may be covered one year, the next year it may not be covered. This creates absolute chaos and panic when patients depend on their insurance to cover these services, and then lose that coverage. 3) An interesting (and devious) thing about insurance companies is that they force healthcare providers into contracts that dictate exactly the kind of care they can give if they want to be reimbursed for their work. This results in a kind of "cookie cutter" hormone therapy that focuses on the lowest cost to the insurance company, where the patient's individual needs are not able to be met because of the inflexible contract the insurance company forces the provider to comply with. We would rather continue to provide individualized care the way it is meant to be than be concerned with only selecting the lowest cost hormone options so as to save money for the insurance companies. 4) Hateful lawmakers can easily outlaw insurance companies from covering gender affirming care. And with the ever-changing political environment right now, this is a distinct possibility. ***Those with insurance coverage may be interested in the service offered by Reimbursify. This business will file a claim with your insurance company for you to see if you can get reimbursed by your insurance for a visit with us. The first claim they file for you is free, and after that it is about $4 per claim. Look them up at https://reimbursify.com/individual-page/ Alternatively, you can also file a claim on your own for "out of network" coverage reimbursement directly through your insurance company by asking us to generate the form with the info you will need to do so. -This reimbursement for out of network coverage will not work for Medicaid or Medicare, however. It is more geared towards commercial insurance policies.

Cost varies if insurance is covering them depending on what your benefit allowances and copays may be. If paying out-of-pocket, then in general, medications cost between $10-$40/month. It is hard to put an exact cost on it because each pharmacy is going to have slightly different prices, so sometimes you might want to shop around a bit before settling on one. Another factor is that not every patient will be placed on the same medications and/or doses, and this can also make the prices vary. A good resource to investigate the prices of medications with is GoodRx. It is a handy phone app and website that you can use to research medication prices, and it also includes coupons you can use to lower your overall prescription price.

If using insurance: This amount can vary widely based on what your allowable benefits are and whether you have to pay a copay, meet a deductible, or pay a percentage. Contact your insurance company ahead of time to ask how they cover lab related claims. If paying out-of-pocket: Depending on type of hormone therapy (T or E) and how long you have been on HRT, the average cost falls somewhere between $50-$100 per lab panel through our lab partners, Quest & Labcorp.

The monthly fee is charged every month, independent of when you may have appts. It is meant as a way to spread out what the cost of a stand-alone appt would be if someone saw an specialist and paid them per appt each time they were seen. The average cost for an endocrinology/specialist appt runs around $250-$400 per appt, for reference. So what we do is spread the cost of appts out over the entire year, thus averaging their cost out in monthly payments rather than having folks pay a huge chunk of change each time they have an appt. For reference, the total spent per year from $50/month is $600, and the total spent per year from $40/month is $480. This is still less than the cost of two appts to an endocrinologist. In general, we schedule our appts somewhat more often during the first 12 months of HRT and space them farther apart as time goes on. The monthly payments also include any ancillary services we may provide as well, such as our messaging service and letter writing for surgery or name change/gender marker changes, etc.

Telemedicine is a convenient form of healthcare able to be performed via live streaming video chat sessions. It operates kind of like how FaceTime, Zoom, or Skype works. You and your healthcare provider will meet via a computer, phone, or other electronic device with video/audio capability. That way, you can complete your visit at home, bringing your healthcare directly into your living room!

Essentially, an asynchronous appt is a type of appointment where video messages are sent back and forth between yourself and your provider through our secure communications app in order to complete your visit. So instead of doing a "real time" discussion all at once that starts and ends at a specific time of the day, your appt can start at any time you are available, and can take place over a longer period of time, allowing for more convenience to fit things into your schedule and putting less pressure on you time-wise overall. It works sort of like a Snap Chat conversation, sending video messages back and forth. For more info, watch the explanation and how-to video below. Asynchronous Appt Video Explanation and How-To: https://youtu.be/P8bDjOd8Eo4

-If you have never been on HRT before, then you will do an initial appointment first to discuss and set your plan in motion. Labs are obtained before medication is prescribed. -After that, you will follow up 3-4 months later to get repeat labs ordered and discuss your progress. -Then, you will follow up about every 6 months (but don't worry, you can always ask questions through our secure text app, Spruce). -Some individuals may desire only yearly appts, and this is fine, but it goes by your own comfort level, and you can always return to more frequent appts. *Frequency can also be determined by your age, physical health, mental health, and stability of your hormone levels. The longer you have been on HRT, the less frequent your visits will be required to be.

Appointments are scheduled here through our website. Click on the "Appointments" tab in the site menu, select your state, and then select your appointment type. It will then ask you for your time zone, a date, and a time to select from our available openings. Afterwards, it will ask you some preliminary questions about yourself, and once you are done, you will submit the appointment request. Tadah!

In most cases, video chat is perfectly fine. This can depend on many things, especially what your needs as the patient are. Some people are not comfortable unless they are sitting in front of a person while others are perfectly fine being seen from a distance. You must decide what is right for yourself in that regard when booking an appt with us. **Please note that in-person appts may be suspended during times of high threat levels (yes, it happens often enough)***

No. You do not need a referral. You do not need a mental health letter either. We believe in informed consent for starting hormone therapy, meaning that we educate you and you decide for yourself if you are okay with everything hormone therapy can involve.

Yes, but it may require some extra effort for you due to current federal laws about licensing, visits, and type of medication (testosterone vs estrogen). If this is what you will be doing, please email the clinic ahead of time with some details about your situation to make sure you will be able to comply with those laws. Email at: spectrum@theotherclinic.sprucecare.com If we are able to accommodate you, we will usually try to space appts out every 6-12 months when someone does this so that they don't need to travel into the borders of one of our licensed states as often.

Yes! We use a secure chat app by Spruce Healthcare to text, send pics & documents, and do video visits.

Sure! You can always email or text us on the clinic line for questions you have. Hormone therapy is not for everyone, so we want you to be comfortable when starting. Go to our Contact page on this site to message us ahead of time.

We currently see those who are ages 18 and older. You will need to upload a copy/pic of your driver’s license (or other government issued ID with birth date) during the registration process to serve as proof of age and identity.

Perhaps. Many will. But health insurance companies all provide different amounts of coverage benefits. *Check with them to see if you have a deductible before lab costs are covered. And you may also want to ask them if you have to pay a copay for labs, or a certain percentage of the lab costs overall. -Even if your insurance doesn't cover labs, there are other options. Just tell your provider. We are partnered with both Labcorp and Quest lab companies so that you can purchase labs through them for a reduced cost (average cost is between $50-$100).

Depending on type of hormone therapy and how long you have been on HRT, the average cost falls somewhere between $50-$100 per lab panel through our lab partners, Quest & Labcorp.

Depends on if you are covered by insurance or paying out-of-pocket: -If using insurance coverage, then you may be able to go to just about any lab that accepts your insurance. See our Labs page for more info. -If paying out-of-pocket, you will be going to a Labcorp or Quest location that we are partnered with. See our Labs page for more info. Either way, there are ample options available.

It depends on the stage you are at, length of time on hormone therapy, your age, your overall health, and the stability of your hormone levels. In general, we do labs once before starting medication, then 3-4 months after starting medication, and then go to every 6 months when your hormone levels are stable (eventually going to every 12 months depending on your hormone level stability and personal comfort level).

It may, but if you don't know, you should contact your insurance company and specifically ask them if they cover "gender affirming care" related services for transgender people. Even if they do "offer" coverage, many insurance companies make it so difficult to qualify for the coverage to actually be used that it is the same as if they didn't cover it at all. 🙄 *See our other FAQs questions for info on medication and lab costs out-of-pocket. Honest Advice: Plan for them to not cover it, then it will be a pleasant surprise if they do.

In general, medications cost between $10-$40/month. It is hard to put an exact cost on it because each pharmacy is going to have slightly different prices, so sometimes you might want to shop around a bit before settling on one. Another factor is that not every patient will be placed on the same medications and/or doses, and this can also make the prices vary. A good resource to investigate the prices of medications with is GoodRx. It is a handy phone app and website that you can use to research medication prices, and it also includes coupons you can use to lower your overall prescription price.

Depending on your situation, you may choose to pick up prescriptions from your local pharmacy or have them mailed to your house by a mail order pharmacy.

Of course, this will depend on the type of HRT you are choosing (testosterone or estrogen) as well as your transition goals and many other factors. But the general medications we routinely prescribe for HRT and HRT related issues are listed below and is not a complete and exhaustive list: Estrogen HRT: -Estradiol (pills, injections, patches, cream, etc). -Progesterone (pills, cream, etc. Injections not recommended but you can discuss the reasons with your provider). -Spironolactone -Bicalutamide -Finasteride -Dutasteride -Lidocaine topical (for hair removal procedures). Testosterone HRT: -Testosterone Cypionate and Enanthate (injections, cream/gel, patches, intranasal, etc). -Birth control pills, injections, and patches -Anastrozole -Tamoxifen/Raloxifene -Finasteride -Dutasteride *As mentioned above, this is not a complete and exhaustive list but just the routine things that can/may be prescribed.

Everyone is different, and some effects are more rapid in onset than others. It can also depend on the age at which you start. In general, it can take anywhere from 4-5 years to reach the maximal effect of hormones, but some effects can be seen within the first 3 months. Think of it this way: It is like a second puberty. You didn't go through your first puberty in less than a year, did you? The same rules apply here. Your body needs time to adjust and grow!

Yes and No. Some effects, such as deepening of the voice or development of breast tissue, are permanent. But many effects are not. It can also depend on the length of time you have been on hormones. This is another topic you will be learning about during your visits. You can also check out our Youtube channel as we have a videos that covers this exact topic. A couple of examples are below:

That is, of course, your choice. And it is perfectly fine. You should inform your provider, though, so they can instruct you on how to safely taper off of hormone therapy so as to minimize any side effects and/or unpleasantness. One of our Youtube videos discusses stopping HRT: