TABLE OF CONTENTS

About labs

Blood work (which we also call “labs,” short for laboratory tests) is an essential part of monitoring your health, progress, and safety here. At Plume, your medical provider orders your labs and our nurses ensure that your lab orders are sent electronically to Quest Diagnostics, Plume’s clinical laboratory partner. When this is completed, a nurse will send you a message via Spruce with instructions on how to schedule your lab appointment. Wait until you receive that message to schedule: otherwise there will be no lab order ready when you arrive.


Labs must be scheduled with Quest Diagnostics to be covered under your Plume membership. If you schedule labs with any third-party Quest center that is not a Quest Diagnostics, your Plume membership does not cover the lab cost. Make sure the facility you choose says “Quest Diagnostics” in its name! You can find your closest Quest Diagnostics here.


NOTE: Quest will ask for your legal name and sex (if you’ve already changed your name and gender marker, this will be reflected in your medical chart and at the lab). We can add a note with your chosen name in the order to make you more comfortable, unless you advise otherwise.


Preparing for your appointment

  • There is no need to fast before your appointment. Eat and drink normally.

  • If you inject medicines, get your blood drawn midway between injection days. For example, if your injections are on Tuesday, schedule your blood work for Friday or Saturday. 

  • If you take tablets, schedule your blood draw approximately six hours after your dose.

  • If you use a gel, apply the gel away from the inside of your forearm where your elbow bends or get blood drawn in the other arm. Having gel on your skin at the draw site can skew your test results.

  • Please be advised that most Quest locations require a mask to enter the building and to receive care. You may contact your individual Quest location for more information. 


The day of your appointment

  • Once you arrive at the facility on your scheduled day and time, check in using your name exactly as it appears on your legal ID.
  • If the clinic can’t find your order, tell them Plume is a national account. This ensures they are searching using the correct information.
  • The cost of your labs is billed to Plume. There is no need to pay or use insurance. This information about your account is included in the electronic lab order. If the lab asks for a payment, have them check the order.    

After your appointment

Your provider should reach out within 2 weeks to discuss your lab test results. They can explain the results, answer any questions, and speak with you about whether any dose adjustments make sense. If you have not received your results within 2 weeks, please notify your care team in Spruce and we will follow up with Quest Diagnostics. Please know that carefully reviewing your results is very important to your medical provider. Since providers usually have many labs to review at once and they want to take the proper time to thoughtfully ensure how your results may impact your care, we kindly ask for your patience! If you want to review your results as soon as they come in (which may be before your provider has had a chance to look), you may create an account online with Quest Diagnostics to access your results. 


Labs must be scheduled with Quest Diagnostics to be covered under your Plume membership. If you schedule labs with any third-party Quest center that is not a Quest Diagnostics, your Plume membership does not cover the lab cost. Make sure the facility you choose says “Quest Diagnostics” in its name! You can find your closest Quest Diagnostics here.


NOTE: Due to telehealth laws in New York, New Jersey, and Rhode Island, Quest must bill all New York, New Jersey, and Rhode Island patients directly for labs, and the patient must pay Quest. Disregard Quest’s regular pricing; it will be Plume’s membership rate (around $30-35) when you are sent a bill. Your membership is $90/month instead of $99/month to account for quarterly lab charges


Which tests will be ordered?

For patients on testosterone

  • Testosterone levels

  • Hemoglobin and Hematocrit (H/H)

 

For patients on estradiol 

  • Estradiol levels

  • Testosterone levels

 

For patients taking Spironolactone

  • Basic metabolic panel (BMP)

  • Estradiol levels

  • Testosterone levels

 

Why do I need to complete labs when receiving gender affirming hormone therapy?

Getting regular “labs” (laboratory tests) is important while on hormones. This is for two big reasons - to make sure your levels are within a safe range AND to give us a sense of how effective your regimen is.   


For patients on testosterone, we want to make sure your testosterone level isn’t too high and that your hematocrit (your concentration of Red Blood Cells or RBCs) is in a safe range. This helps us keep you as safe as possible and minimize the risks of testosterone. Your testosterone level also helps us determine how effective your dosing is. Your lab value isn’t the end all and be all - it’s just one piece of information that your medical provider will factor into a conversation with you about how you’re feeling and the changes you’re experiencing. 


For patients on estrogen, we measure estrogen levels mostly for safety. Estrogen levels aren’t the best measure of how effective your regimen is, but we check them to make sure they aren’t super high. When estrogen levels are too high, this increases the risk for side effects (like a blood clot, for example) without giving you more benefit. Your testosterone levels are more helpful in telling us how effective your regimen is. Our goal is to see your testosterone levels dropping. Again, it’s important to know that your lab values aren’t the end all and be all - they’re just one piece of information that your medical provider will factor into a conversation with you about how you’re feeling and the changes you’re experiencing.


How does lab testing work through Plume?

Plume has partnered with Quest Diagnostics, a national clinical laboratory that provides convenient lab draws from over 2,200 sites throughout the United States. The way it works is: 


Step 1
Your Plume provider places the order for blood work.


Step 2
When your labs are due, our Plume nurses will send you a message in the Spruce app with your order. They’ll also send the order to Quest! 


Step 3
You’ll schedule an appointment at any Quest Diagnostics lab site in your state to get your blood drawn.

If you inject medicines, get your blood drawn midway between injection days. For example, if your injections are on Tuesday, schedule your blood work for Friday or Saturday. 

If you take tablets, schedule your blood draw approximately six hours after your dose. 

If you use a gel, apply the gel away from the inside of your forearm where your elbow bends or get blood drawn in the other arm. Having gel on your skin at the draw site can skew your test results.


Step 4 
Within two weeks or less, your care team lets you know the results and our follow-up recommendations via the Spruce secure app.

 

Labs must be scheduled with Quest Diagnostics to be covered under your Plume membership. If you schedule labs with any third-party Quest center that is not a Quest Diagnostics, your Plume membership does not cover the lab cost. Make sure the facility you choose says “Quest Diagnostics” in its name! You can find your closest Quest Diagnostics here.


How much will I pay for labs in New York, New Jersey, or Rhode Island?

Due to telehealth laws in New York, New Jersey, and Rhode Island, Quest Diagnostics must bill all New York, New Jersey, and Rhode Island patients directly for labs. Then, the patient must pay Quest Diagnostics directly. However, even though patients in New York, New Jersey, and Rhode Island pay out-of-pocket, you receive a significant discount on Quest’s regular pricing for quarterly lab charges. Quest Diagnostics will send you a bill that charges around $30-$35. In consideration of this extra cost, your Plume membership costs $90/month instead of $99/month.