A recent study found that one in five Gen Z adults identify as LGBTQ. Meanwhile, 50% of LGBTQ+ people report some form of healthcare discrimination. The stats don’t lie. There’s a significant and growing LGBTQ+ community that isn’t being served by America’s incumbent healthcare system. Enter Folx Health, the first healthcare platform designed specifically for queer and trans people. Launched in 2020, Folx is an archetypical People’s Champion — radically rethinking every part of the healthcare process through the lens of their community’s needs. We caught up with CEO Liana Douillet Guzmán to learn more about how Folx is challenging incumbent healthcare, how its values impact the business and the advocacy it does outside of healthcare for the LGBTQ+ community.

Liana Douillet Guzmá, CEO of Folx Health. Photo: Folx

Hi Liana, what’s wrong with the current healthcare system?

The healthcare industry is not really patient-centred. The incumbent system puts payers and insurers at the centre of many of the decisions made around health care. And so, more broadly, there is a need for health care that is patient-centric and consumerized. That doesn’t mean that, as consumers, we get to decide every part of our health care; we still want to partner with expert clinicians. But we want them to treat us as partners in our care. We want them to know that although they know the medicine better than we do, we know ourselves better than they do. And so it’s about enabling that autonomy, and more broadly, that’s something we need in healthcare that Folx is championing.

Then, as you zero in on our community in particular, we surveyed our membership, and 78% did not have access to affirming care before they found Folx. 71% actively avoided seeking care because of fear of discrimination. And that fear is well founded; more than 50% of us have reported discrimination in a healthcare setting — and we know that for every person reporting it, many more aren’t.

So the incumbent system is often discriminatory, and even when it’s not, it lacks expertise. The average clinician graduates with five hours of LGBTQIA-specific training throughout their entire education. And the reality is we have medically differentiated needs. I have two kids, and the way I built my family looks very different from my straight counterparts. And as a community, we suffer from higher rates of mental health or substance abuse issues because every day can feel like a battle as part of the queer community. Our community wakes up daily to stories about people trying to take away our rights.

And those are macro aggressions, but we experience microaggressions, too. I was at an event recently and felt distinctly uncomfortable when someone asked me what my husband did. And I said, well, it’s actually my wife. So those little moments are the baggage we carry. And so having clinicians who look like us, understand us, and have invested in creating this queer-centric expert approach is deeply important.

I’m a big believer that Folx can change healthcare, and the first thing I care about is doing that for our community. But I think by creating that patient-centric approach for our community, we can shift how healthcare is provisioned more broadly.

How do you get the company to coalesce around that vision?

I think this is where my branding background comes into play. So I come from the school of the importance of brand marketing. And I don’t think the brand is marketing. For me, the brand is core to the identity of a business; it’s who you are. What do you stand for? What are your values? And then, really importantly, who don’t you stand for? What don’t you believe? What won’t you do? So communicating the broader goal to the team starts with identifying why and how we exist.

I’m a big believer in going slow to go fast. So when I joined, for the first 60 days, I made no real decisions. My entire purpose was doing a listening tour, where I got to know the people who built this company from the ground up. And so, even if I had ideas that seemed great, I’d wait until day 60. And what ends up happening is by day 60, you realise that half of the ideas you execute against, your instincts were right, and half of the ideas, you were an idiot. And as you’ve learned more about the business, you realise some ideas were terrible. So after 60 days, when you start to roll out changes or perspectives, you’ve built relationships and trust with the team. It seems like you’re wasting time, but actually, it means when you enact changes, you’re not fighting upstream. Instead, there’s a team of people who are happy to execute against the vision with you.

And so it started there for the team and me. First, it was, what are our values? Our values are accessibility, reliability, transparency, and autonomy. And then, how do we translate those values into the care we provide for our members?

Folx offer estrogen memberships for transgender and non-binary people. Photo: Folx Health

What kinds of patient-centric care does Folx offer the LGBTQ+ community?

We started with HRT (Hormone Replacement Therapy) because the trans community is the segment of our community that is most underserved and faces the greatest systemic discrimination. So we wanted to become a safe place for folks who need affirming care to get HRT through Folx. And so, today, if you want to start taking HRT, the average wait period is six months. At Folx, it’s a couple of days. So for us, it’s about providing a best-in-class product in an accessible way.

So, we started with the trans community and HRT, and we have heard loud and clear from not only members of the trans community but also members of the LGBTQ+ community. And our community wants support in three areas.

First is virtual care. Generally speaking, the healthcare industry is filled with judgement and gatekeeping for our community. And so we’re taking all of that away and creating the space to provide an affirming expert telehealth experience.

The other thing folks want is access to mental health services. And so we started offering peer support groups. So in the next month or so, we’ll launch expert-led support groups and then move from there to other forms of mental and behavioural health.

And then the last pillar is content and community. Our community wants to connect with other folks who have shared experiences, particularly those not in cities like New York or San Francisco, where the community is concentrated. So, for example, we do shot parties where a nurse comes in, and for people taking testosterone, they all inject together with a nurse’s help, creating that community and connectivity.

And so those are the three areas where we’re focused, and that’s informed by what our community has told us they need.

Folx’s ‘Say Gay’ billboard in Florida speaking out against anti-LGBTQ+ legislation. Photo: Folx Health

How do you approach developing the Folx brand identity for the LGBQT+ community, and where do you source inspiration?

A better word for healthcare brands would often be sick care, right? Because they exist to help people when they’re sick. But what we want to do is help people live healthy and fulfilling lives. And at the very base of Maslow’s hierarchy of needs is the ability to access care so that you can stay healthy and be fully yourself before moving up the pyramid into finding that fulfilment, etc.

So our mission is to be the leading health and wellness platform for the LGBTQ+ community across the full spectrum of needs. And it’s a full spectrum, it’s important that we are a lifestyle brand that people can tie into on an ongoing basis, versus a typical healthcare brand, which is episodic, and people come in and out and don’t build those long-term relationships. And so we think about the brand almost like a friend and ask ourselves what that looks like. What does that feel like?

And then, the source of inspiration is our community. Our community is at the core of how we think about the brand. We are people who have had to step out of the status quo and live our lives in a way that we often heard throughout our entire childhood was unacceptable. And we’ve had to make our own way, build our own communities, and take ownership over the ways in which others have tried to diminish us. And so that is our brand; we want to be loud and proud. We want to highlight the stories of members of our community who have laid the groundwork for where the queer movement is today or who are at the forefront of it and, in real-time, leading us to what it will be tomorrow.

We also feel like we’re in a position of great privilege, and so a big part of what we do as a brand is create that umbrella of safety for others. So when places like Texas and Florida were passing anti-trans bills or anti-gay legislation, we took up billboards and flew planes and wrote op-eds and created that clear space for folks who maybe felt abandoned by their government officials to look up and say, ‘Oh, I'm not alone, and Folx has my back, and they’re putting their money where their mouth is.’

Can you tell us more about the Folx’s advocacy work?

What is unbelievably powerful about this brand and the marketing team behind it is the consistency with which they are executing important work. And so, instead of being a brand that does one big, beautiful thing a year that we then ride the coattails of for months, our goal is to consistently do the right thing in a way that is impactful. And we are consistently a voice for our community, and we are taking the front lines and leading the charge.

We created a video for Pride Month called Future Legacy, which interspersed folks from older generations who were on the frontlines of places like Stonewall with this next generation — Gen Z, who are pushing us to get so much more. It honours our legacy while celebrating the future and makes clear that we haven’t come as far as we need to.

I’m deeply proud of the ‘Say Gay’ billboards we did in Florida or the ‘Trans Lives Matter’ billboards we did in Texas, where we could be a voice for those who don’t have a voice. And then we featured Monica Helms, a transwoman who created the transgender pride flag in an Instagram story, which again was about us centring on our community and making it about them and their stories.

I think the most important advocacy work is often done quietly; it’s not enough to just take out these billboards. We’re supporting organisations like BTAC, the Black Trans Advocacy Coalition out of Texas, which is a nonprofit, and we’ve partnered with them on our HRT fund to provide free HRT to folks who can’t afford it, I think 80% of whom are people of colour.

And we meet with various government officials and lawmakers on a regular basis to help tell some of these stories and explain to them that there are deep health and wellness needs.

Part of what we do is make it very clear where we stand. So when the Dobbs decision came down, we put it on our website that we believe, again, back to that value of autonomy, in people's right to do what they wish with their bodies. And so again, just being front and centre about that, so people know where we stand. And hopefully, we can help drive change that way.

The Folx Library — a free information resource for the LGBTQ+ community. Photo: Folx Health

Folx launched ‘The Library’ last year as a free resource, why is that so valuable to your community?

We’re a source of trusted information for our community. There’s a lot of information out there that’s either incorrect or steeped in judgement and scapegoating. And even academic papers — we’re not a community that the incumbent model is invested in terms of building a broad understanding. And so being able to go to a place where you know you’ll get clinically accurate information that is free of judgement is something that we knew that we could do better than anybody else.

And at the core of who we are, is a desire to provide care to this community across the board. And so, The Library is not behind a paywall because it’s not something that we feel people should have to pay for; we feel like people should have access to this information. And until we built our library, there wasn’t that place to access trusted information. And so we work really closely with our clinical team to put really thoughtful clinical guidance out for our community.

For many of them, it is their entry point into affirming care. Being able to access the basics so that when they come in to meet with a clinician, they’re coming in informed and with their own perspective on what they want their care to look like. And so then that becomes more of a conversation than what many of us are accustomed to, which is have a clinician throw a bunch of directives at you, and by the time you’ve processed the information, they’re gone.

So again, it’s that patient-centricity. And so, providing that information as a basis from which to build that clinical relationship is deeply important and very different from the incumbent model.

Are there areas of the business that you've had to sacrifice because they don't contribute to the company's values or mission?

We’re focused on the LGBTQ+ community. And people often tell us that there are a lot of people who want care that is affirming and would want to support a brand like Folx, but while we’re not going to turn people away, that is not our focus.

That plays out in our hiring too. So, we have put processes in place to make sure that we’re prioritising hiring members of our community. These people are often disenfranchised when it comes to the hiring space, so we start with a two-week sourcing period where we only source from members of our community. Now, at the end of the day, we’re going to hire the right person for the role, but building equity is giving people who are disadvantaged a head start. And so that’s really how we think about it. And that means that our hiring process takes longer, and sometimes we go without the right person for longer because we’re prioritising making sure that we have a really equitable space.

We also have a no negotiation policy for salaries in the final stages. And we do that because research shows that the only people that benefit from negotiations are white cis heterosexual men; everybody else gets penalised for negotiating. That means sometimes we lose great people because we’re not willing to go up an extra $10,000. Could we afford to? Yeah, but it’s not in line with our values around equity.

What does success look like for Folx?

I want Folx to be a business that changes the face of healthcare and creates an affirming expert place for my community to access care. I want to have facilitated community members to live long, healthy, fulfilling lives. And so, really meeting the needs of our community across their full spectrum of needs is success. Members have told us, ‘this was the best year of my life; thank you for changing my life’. I want to wake up in five or ten years and hear people say, ‘I am who I am because I had access to Folx Health.’

Enjoy this? Sign up for The Challenger Project newsletter from eatbigfish, and we’ll send you our monthly email with our very latest insight, interviews and case studies.

All images courtesy of Folx

‘We want to create that umbrella of safety for the LGBTQ+ community’: Folx Health CEO Liana Douillet Guzmán