Skip to content

Quantifying Transition

A suite of new startups seek to co-opt trans community care

In the never-ending pursuit of wringing money out of even the most historically ignored populations, a recent series of venture capital investments has pointed to gender transition as a site of untapped potential profit. Two telehealth and hormone prescription services, Plume and Folx, announced $14 million and $25 million in Series A venture capital funding, respectively, in early February. Later that month, the transition tech company Euphoria, home to a suite of mobile apps that its CEO refers to as an “Adobe equivalent” for transition, announced $250,000 in additional funding from the LGBTQ venture capital firm Gaingels and, improbably, Chelsea Clinton. Late last year, Euphoria’s CEO Robbi Katherine Anthony spoke with Forbes about the financial opportunities in the trans-tech field. “Our estimates place the average cost of transition at $150,000 per person,” she said. “Multiply that by an estimated population of 1.4 million transgender people, we’re taking about a market in excess of $200B. That is significant. That’s larger than the entire film industry.”

The promotional materials around these companies boast bold fonts, bright colors, and photographs of happy, relaxed people who have presumably used their technology to emerge cleanly from the other side of their chosen gender interventions. They announce an era of trans visibility, a break from the relative secrecy that shrouded much of the transition process in decades past. With technological interventions and venture funding, these companies—whether they deliver tailored advice, virtual medical care, or hormones-on-demand—promise a transition that is smarter, faster, and more frictionless than ever, one that plugs as seamlessly as possible into the broader surrounding world.

That facilitation, however, carries a steep price tag. Plume’s subscription goes for $99 a month, which does not cover the cost of hormones or supplies themselves, only telehealth appointments, labs, and issuing prescriptions to pharmacies. Folx’s quarterly hormone delivery service starts at $59 a month for estrogen and $89 a month for testosterone; the price springs up from this baseline if the user selects a type of medication other than estrogen pills or injectable testosterone. While the first available apps in the Euphoria suite, the informational guide Solace and “self tracker” Clarity, are both free, the company also offers a Solace Plus concierge service, which will “help with one major transition objective” (like finding an informed consent clinic or a trans-friendly clothing retailer via an SMS hotline) for $25 per task. Euphoria recently partnered with Plume, and the Solace app’s advice about hormone therapy is peppered with recommendations to subscribe to the expensive telehealth service.

From the time postwar sexologists began treating transgender people in the United States in th  mid-twentieth century, much access to trans medical care has been predicated on a patient’s ability to move through the world without excessive friction. Doctors working in the wake of Harry Benjamin, author of the paradigm-shifting 1966 book The Transsexual Phenomenon, often declined to offer hormones and surgery to patients who were unlikely to pass in their new gender roles or did not seem, according to psychiatric evaluation, “trans enough” for care. “While the gatekeepers consistently argued that these methods were designed to protect the transsexual, the way they were executed (especially prior to the mid-1990s) reveals an underlying agenda,” writes Julia Serano in the 2007 book Whipping Girl.

Whether unconscious or deliberate, the gatekeepers clearly sought to (1) minimize the number of transsexuals who transitioned, (2) ensure that most people who did transition would not be “gender-ambiguous” in any way, and (3) make certain that those transsexuals who fully transitioned would remain silent about their trans status. These goals were clearly disadvantageous to transsexuals, as they limited trans people’s ability to obtain relief from gender dissonance and served to isolate trans people from one another, thus rendering them invisible.

The recent surge of trans-tech startups pushes against certain aspects of that early model. For one, they’re predicated on the need for a healthy number of consumers to transition so that their subscription numbers may continue to grow; there’s no incentive to turn interested parties away for not fitting a given mold. Plume and Folx both promise access to health care providers who are trans themselves, reducing the need for trans people to rely on cis doctors for early transition care. Solace, meanwhile, advises users on lifestyle goals like “being out in public” and disclosing one’s trans status to family, friends, and coworkers. Instead of invisibility, trans-tech broadcasts the ability—and necessity— of trans people to be seen and understood as trans by a surveilling capitalist superstructure.

But one goal remains consistent. Trans-tech also serves to isolate trans people from their peers—or, more specifically, to profit from the isolation many trans people, especially early in transition, already experience. Instead of encouraging community bonding or pointing people to free resources, trans-tech sweeps the loneliness of trans people into a schema where they can pay for a degree of affirmation and self-realization, so long as they enter a paternalistic relationship between themselves as consumers and the products of their choice.

By forcing transition into a highly surveilled self-improvement trajectory and encouraging cooperation with capital and the state, these startups frame trans people as having a solvable problem.

Trans assimilation is not a new phenomenon; many trans people, notably those who slipped through the gates of scientifically sanctioned medical treatment in the 1960s and 1970s, considered transition in much the same way that the CEO of Euphoria does: as a “chasm” to be bridged on the way to a safe, legible, and productive life. What is new about these apps is the way they transpose the imbalanced relationship between patient and provider long inherent to transition. That dynamic now has trans people on both sides of the equation—as consumers and as doctors and CEOs. These services reroute desires and impulses that may have otherwise led trans people to peer networks and solidarity-building into paternalistic, “expert-led” relationships. Take the coaching group and digital social club Genderfck, another trans-led subscription service with a $99 per month entry fee. The use of terms like “science-backed” and “research-based” to describe coaching methods on Genderfck’s website illuminate the value systems at play; the service calls upon institutional authority and “objectivity” to ordain transition, asking people to make a pricey commitment that the company’s founder nevertheless makes clear is not the same thing as confidential therapy or medical treatment.

Many of these products tap into the precedent of the quantified self, with a clear effort to pixelate transition—a hugely complex process of personal and social change—and map it onto a linear journey of self-improvement, similar to fitness or mental health apps. Euphoria especially encourages users to turn their transitions into a stream of data points, though Anthony has claimed there’s “no data mining” built into the apps. Quantifying transition is more than just another potential incursion of surveillance capitalism into our private lives: it attempts to neutralize an experience that on some level threatens the construct of the stable neoliberal subject, that lets the wilderness of the body inflect the contested domain of identity. In order to pursue transition in the first place, trans people must listen closely to their bodies’ needs, a form of listening that can be dangerous in an economy reliant on underpaid, overworked gig laborers who must override or ignore somatic alarm bells in order to keep earning enough to live. As Os Keyes writes in a 2019 essay for Real Life, “trans existences are built around fluidity, contextuality, and autonomy, and administrative systems are fundamentally opposed to that. Attempts to negotiate and compromise with those systems (and the state that oversees them) tend to just legitimize the state, while leaving the most vulnerable among us out in the cold.” By forcing transition into a highly surveilled self-improvement trajectory and encouraging cooperation with capital and the state (one of Solace’s advice cards beseeches the user to behave respectfully in encounters with the police), these startups frame trans people as having a solvable problem—glitches that can be fixed, rather than potential starting points for systemic transformation.

In another telling snatch of copywriting, Genderfck likens transition to recognizably heteronormative milestones legitimized by consumerist rituals. “I want to build a world where gender transition is celebrated and normalized,” reads the service’s homepage. “A world where, when someone says, ‘I’m getting married!’ ‘I’m having a baby!’ ‘I’m exploring my gender identity!’ the reaction to all three statements is the same: ‘Wow, what an exciting time! Congratulations! Where are you registered?’”

Treating trans people as a captive, untapped market, as these products do, feels especially exploitative of a community that has, according to a 2014–2015 survey, a 31 percent poverty rate, 14 percentage points higher than cisgender people. While a Supreme Court ruling from last June now ensures that trans people will be protected from employment discrimination under the language of the Civil Rights Act of 1964, that ruling does little to redress the generations of underemployment, violence, and criminalization that trans people have continually weathered. Tellingly, Aimee Stephens, the woman whose case helped to form the foundation of the Supreme Court ruling, passed away before the court’s ruling was announced, perhaps the most high-profile (but far from only) person who has experienced the deadly consequences of not hiding themselves from the world.

The next application promised from the Euphoria suite is a savings app called Bliss, a tool meant to help users quantify their goals and save up more efficiently for transition-related medical treatment. “Funds are placed in a mutual fund consisting of a RAINBOW index of public companies with strong commitments to LGBT equality, meaning that you can grow your money with companies who support you,” boasts a blurb on Bliss’s website. The product assumes a niche audience: trans people who earn a sizable and steady enough paycheck to eventually pay for surgery, and who only need an ethically minded guide to steer them through the process of subdividing their income.

The financialization of trans health care hardly comes as a surprise, especially in the United States, where a population that’s already chronically deprived of health care access matches neatly with a medical need that can cost tens of thousands of dollars. Companies like GoFundMe have, for the past several years, become the repository for this kind of support, with fundraising links that circulate on social media working as a stopgap in the absence of other funding. Still, considering that GoFundMe CEO Tim Cadogan recently called the use of the platform “nothing short of a national emergency” with regards to the more than one hundred fifty thousand Covid-related fundraising requests, the dire need for all forms of relief far outstrips such a platform’s ability to provide them.

The app-ification of transness also inherently infantilizes its target consumers, supplanting decades of communal care with expensive access to rarified experts. The past year has made trans experience especially vulnerable to this kind of commodification. Though trans people were already busy finding one another online before the pandemic, being forced to shunt almost all aspects of our social lives into the corporate-mediated digital realm has been disruptive to communities that thrive on shared physical connection. A year into Covid-19 isolation, it’s been increasingly difficult to remember the essential joy of being in community with one another on a sweaty dance floor or a queer beach—shared stages for cruising and company. It is unsurprising, then, that tech startups would seize the chance to profit from that isolation.

While Genderfck founder Rae McDaniel publicly praised mutual aid groups attempting to build lateral support systems in a response letter posted after launching the project to abundant criticism, Genderfck and its cohort nonetheless attempt to package and sell trans kinship back to trans people at a premium. Despite also co-facilitating a free three thousand one hundred-plus person Facebook group that provides some of the communion and guidance that trans people need, especially early in transition, McDaniel’s insistence that their paid guidance is still worth the entry fee rings hollow in the face of so many other kinds of support. Solace Plus’s “concierge” service similarly monetizes information that might otherwise circulate within the community for free. “Think of our advice as something you’d get from a friend,” the website says, adorned with images of cheerful texts pouring in from an anonymous worker on the other side of a hotline—an expensive substitute for the kinds of relationships that require ongoing mutual effort and care.

Profit-seeking trans-tech only perpetuates that myth-making, casting trans sociality as an axis of individualistic striving and self-betterment.

What’s most damning about this trend is the way it denies trans people’s proven skill for hacking our way through life with each other. Across time and space, our ability to live free and joyous lives to whatever degree we can seize relies upon a measure of canniness and foresight that’s unquantifiable and looks nothing like an Adobe product. In the early days of the internet, trans people used the names of prominent elders like Christine Jorgensen and Virginia Prince as chatroom titles to keep AOL from finding and deleting their accounts as they found one another. Today, projects like the Oracle for Transfeminist Technologies draw upon long-cherished practices of divination and tarot to enable new ways of collectively envisioning the future, recognizing transition as fundamentally oriented towards that which cannot be preordained, quantified, or expected. Mutual aid organizations like For the Gworls and G.L.I.T.S. build on decades-long histories of trans people providing for one another outside of capitalist institutions, making nimble use of social media and on-the-ground organizing to secure housing, protection, medical care, and community for people who fall through the holes of rapidly diminishing social safety nets and VC-backed self-help schemes alike.

“A care web works when the work that composes it isn’t exploitative, appropriative, or alienated,” writes Hil Malatino in the (free to read online) 2020 book Trans Care. “This is the gauntlet thrown down by any sustained attempt to collectively cultivate a care web: it challenges us to be deliberate, to communicate capacity, to unlearn the shame that has become attached to asking for, offering, and accepting help when we’ve been full-body soaked and steeped in the mythos of neoliberal, entrepreneurial self-making.” Profit-seeking trans-tech only perpetuates that myth-making, casting trans sociality as an axis of individualistic striving and self-betterment—a literal investment in a future self imagined to be resolved of its conflicts. But there is no other side to the chasm, because there is no chasm to begin with. There’s only the perpetual becoming that transition makes clear, and the opportunities it brings for lateral communion. We are transitioning from nowhere to nowhere, as trans musician Ezra Furman sings, finding ourselves and one another along the way.