A Gynecologist for the Self-Care Generation

How much would you pay to feel heard?

Photo: Kezi Ban of Blonde Artists courtesy of Rockwell Group
Photo: Kezi Ban of Blonde Artists courtesy of Rockwell Group
Photo: Kezi Ban of Blonde Artists courtesy of Rockwell Group

Tia, a new membership-based women’s wellness clinic located in New York City’s Flatiron district, is the first tenant in a renovated building, and when I arrive on a Thursday evening, the main elevator isn’t working. To my genuine delight, a friendly doorman ushers me into the freight elevator instead, promising me it’s safer than it looks.

Elevator notwithstanding, Tia’s interior is pristine, beautiful above all else: The lighting is soft; the walls are white and speckled, the couch (which comfortably seats two, two and a half) is soft peach leather, and the three ottoman chairs are geometric and bright; the selfie mirror is adorned on either side with tall, lush green plants. A small refrigerator is stocked with Recess-brand seltzer (CBD and adaptogen-infused), perhaps the clinic’s only non–woman-owned product; its founder is Tia co-founder Carolyn Witte’s brother. A number of vibrators are displayed for sale, including one for couples called the “Dame Eva,” which costs $135, and is cradled between the paws of a plump ceramic rat, which is cuter than it sounds. On the bookshelf lining the seating area I see Joan Didion, Simone de Beauvoir, Roxane Gay. The music is trendily beep-boopy and the burning candle smells amazing.

When I meet them, a week after their March 7 opening, Witte and co-founder Felicity Yost, both 28 years old and wearing voluminously sleeved blouses, cheerfully lead me into an empty exam room for our interview. I get to sit on the swivelly doctor stool. There they tell me the origin story of Tia, which was originally created to be a birth-control recommendation app women could bring to their doctor’s offices. Soon after launch, Yost tells me, the app’s users expressed a desire to ask Tia other, non–birth-control related questions about their health. In response, Witte and Yost ran Google ads for common women’s-health search queries they planned to answer, like, “I think I have an STI,” and were so overwhelmed with questions they turned the ads off after four hours. Having solicited users’ phone numbers via custom Squarespace page, Witte and Yost began texting with these women about their concerns, drafting their replies from the recommendations of hired medical advisers. “They wanted to track their cycle with us, they had follow-up questions, they started chatting with us like we were their friend instead of this random website they put their phone number into,” says Yost.

Neither Yost nor Witte has any medical background, a fact which they argue has allowed them to view the health-care system from a patient-first perspective. Prior to developing Tia, Witte previously worked at Google leading a creative design team, while Yost ran product at a start-up called Owler, and their approach to health care is very Silicon Valley–esque: Here is a need we’ve been meeting in another, inferior way for decades, and here is an app to make meeting it simpler, faster, and cheaper. “Both of us are really motivated by this idea of innovating on the service model to address improving women’s health outcomes at a time when they’re getting worse instead of better on almost everything that matters: maternal mortality; more women are diagnosed with autoimmune disorders; endocrine disorders; mental health,” says Witte. “From a cost perspective, everything’s going up, not down. You name it, it’s getting worse.”

As for their goal to innovate on the U.S.’s exorbitantly expensive health-care system while charging a $150 annual membership, over and above any services rendered, Witte says their fee will be what keeps them in business — unlike, say, Planned Parenthood. “The existing, purely publicly-funded women’s health centers are under attack, and those business models and funding models aren’t sustainable,” says Witte. “We need to both support those, and also, I believe, not put all of our eggs in one basket, and create new ones.” Comparing their fee (which can also be paid out monthly, for $15/month) to a Spotify or Netflix subscription, Witte says the added cost will allow Tia to improve care quality, and over time, they hope, “change the game for women’s health.”

The way they hope to accomplish this is largely through patient/provider communication and data tracking. Tia’s patients can track not only their periods with the Tia app, but also their “acne, their bloating, their nutrition, their sleep, stress, sex life — everything that’s interesting for a woman,” says Yost. Still, the period is paramount. Witte and Yost call the Tia philosophy “Cycle-Connected Care,” calling the menstrual cycle the “fifth vital sign,” a recognition that “to be female, is to be cyclic.” (It seems worth stating here that though Tia’s official policy is to welcome all patients, “No matter what gender you identify with or who you love,” the clinic doesn’t seem especially well-versed in trans- and queer-inclusive language, let alone medicine — Tia does not provide HRT, for instance, though they will make referrals to “experts in transgender care.”) At Tia, one’s period is the foundation of one’s health — the first thing tracked, but far from the last.

When Witte and Yost walk me through a mock appointment, the patient, Tanya, presents with what she believes is an irregular cycle and a desire to lose weight. (All of this information is presented on a large flat-screen TV for the patient and an iPad for the provider — Witte says one of Tia users’ chief gynecology complaints was feeling that their doctor was hiding behind a computer.) The average gynecologist, says Yost, will listen to Tanya’s description of her irregular periods and weight issues, but once she sees that Tanya’s on birth control, she’ll dismiss those irregularities and weight gain as symptomatic to that medication. The Tia gynecologist, by contrast, connects the dots. In this version of the appointment, the gynecologist asks Tanya about her diet (she’s dairy- and gluten-free), her sleep (five hours average), and her stress levels (high), looks into her family history, and provides her with a range of care plan options. In Tanya’s case, this includes: blood work, including a vitamin D panel; a metabolic panel; an autoimmune panel; more sleep; and acupuncture, turmeric, and MitoQ10 supplements for her stress. Conveniently, Tia can help Tanya with all of the above: In addition to the lab work, the clinic provides a full-time, on-site acupuncturist and sells a range of dietary supplements. And vibrators.

When asked if it might not be considered a conflict of interest to sell those products which they prescribe to patients, Witte demurs. They don’t sell their own brand of supplements, like other wellness clinics do, and if the doctor hears that a patient already has an acupuncturist, of course she can go there instead. The clinic purposely doesn’t display more than one of each item for sale so patients don’t feel pressured to buy, Witte adds, explaining that the inspiration was a store in Soho called “One Line,” which is designed to look like somebody’s living room, only everything’s for sale. They only sell products they believe in, and, whenever possible, products made by women, for women. And, says Yost, much of what they sell is informed by research they’ve done into their own health issues — in Yost’s case, an autoimmune disorder, and in Witte’s, PCOS. “As nerds who care a lot about health and spend our Saturday nights reading academic journals, we’re here to share some information,” says Yost. “It’s not like, come buy our vitex because we get a kickback. It’s much more, ‘Hey, vitex is really great for PMS in women who are on birth control, and we think [ours] is a great brand because it’s made with entirely organic herbs, and it’s a vegan capsule that makes it through the esophagus and isn’t dissolved by the stomach acid.” In any case, says Witte, product sales are a “very, very, very tiny” part of their business model.

The bread and butter of the Tia operation, says Witte, is the well woman exam, like the one demonstrated by the fictional Tanya. For this alone, there is significant demand — Tia saw 135 patients in its first five days, they tell me, far more than expected. What they’ve seen from those women, says Witte, is an eagerness for information and actionable solutions. “Women are reaching out proactively and saying, ‘I’m waiting for my care plan.’ This is the thing they’re most excited about,” she says. Contrasting their diagnosis model to what Witte calls the “patriarchal, patronizing” formula in which a (usually male) doctor hands over a prescription and sends you packing, Tia offers women a plan. It is easy to see the appeal here. If my period is weird and I’m tired and stressed, I don’t always want to be told that nothing is wrong with me. I want pills and salves and a trip to the acupuncturist down the hall. In our current cultural moment, there is nothing more attractive than a regimen, specific and self-assured. Our bodies are our projects, and we’ll never be finished with them (until, that is, we die). If you go to Tia, at least you know you’ll leave with something to do.

For women especially, whose health concerns are too often minimized or dismissed by doctors, the promise of a doctor who takes your every physical/emotional/mental fluctuation seriously is a godsend, and could genuinely save lives. For now, though, their means to do so are rather limited. Tia, while nominally pro-choice, does not perform abortion services, for which they received some pushback in their first week. “We will do abortion, and when we do it, we’re going to do it in the best way, which means absolutely providing medication abortion, but hopefully getting into surgery as well,” says Witte. “We have one MD, one nurse-practitioner, and we’re still a small care-team today. We don’t do surgery, we don’t do pregnancy yet, we don’t do fertility. There are a lot of things we don’t do.” (Incidentally, many Planned Parenthood clinics do all the above.)

What Tia can do (besides STI screenings, UTI tests, pap smears, prescribing birth control, and other standard gynecology services) is make a patient feel heard, which, of course, isn’t nothing. In its inaugural New York clinic, Tia does this via upgraded well woman exams with a gynecologist who looks you in the eyes. As an app, Tia does this by living in your phone, keeping track of your periods and your diet and your sleep and your stress and your sex life. Tia makes healthcare feel DIY, and fun: In the app, she’s an entity, popping up to text you reminders using emojis. “Our users describe [Tia] as, ‘She’s like your best friend who’s in med school. She sounds like she’s 29, and sends you Beyoncé GIFs, but reads academic journals,’” says Witte. What more could you want from a doctor?

A Gynecologist for the Self-Care Generation