Launch HN: Fella (YC W20) – Tackling men's obesity using medication and coaching

[rich-cartwright]

Hey HN! I'm Richie from Fella (https://www.joinfella.com), a telehealth clinic for men with obesity. Fella helps men get to a healthier weight by matching them with a board-certified obesity doctor to prescribe an FDA-approved medication, while they undertake personalized health coaching.

I personally struggled with stress eating for 6 years. During that time, I was at Cambridge University, then built and sold my first company working with the UK government. It was tough, and poor eating habits as a teenager became a coping mechanism as an adult.

Fella first started as a "CBT+community" product to help men battling stress eating. It resonated due to the stigma around men's eating struggles. But we realized we were only half-serving most of our customers: even when no longer stress eating, most guys weren't getting to a healthier weight.

So we started researching effective, evidence-based treatments for obesity. When I say "we", I really mean my co-founder Luke. He studied medicine at Cambridge University, developing a patented AI approach to detecting cancer at a YC bio company, before moving to Microsoft Research. He parses bio papers better than me...

Obesity treatment is about to radically change. This is thanks to a breakthrough medication — NY Times called it a "game changer" in Feb 2021 [1]. The medication was approved by the FDA in June 2021 [2]. It leads to an average 15% decrease in body weight, efficacy close to bariatric surgery [3]. However, medication-assisted treatment for obesity is still stigmatized by family doctors and therefore hard to access.

Moreover, only 10% of those using weight management services are men, despite men representing 50% of those with obesity. This is because almost all programs market to women, placing too much emphasis on looks and not enough on health for a male audience. Stress eating is widespread among bigger guys, but mostly ignored — with too much focus on willpower and "eat less, move more". This needs to change.

So we pivoted to the Fella you see today: a telehealth experience with a board-certified obesity doctor for FDA-approved medication, combined with personalized health coaching. We went live in Texas in July, and are soon to be live in California and New York. Fella is a 12-month program and costs $149/month, paid quarterly. We’ll bring costs down over time to improve accessibility.

We still have lots of difficulties ahead. The main one could be insurance reimbursement: the latest wave of medications are expensive and insurers don't like to cover them [4].

We’re excited to hear your ideas, questions, concerns, feedback — and maybe any personal stories. I’ll be responding to comments all day, or feel free to shoot me an email at [email protected].

[1] https://www.nytimes.com/2021/02/10/health/obesity-weight-los...

[2] https://www.fda.gov/news-events/press-announcements/fda-appr...

[3] https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

[4] https://www.bloomberg.com/opinion/articles/2021-07-19/weight...

[issa]

I am curious if this question has come up in company marketing discussions. One of the most common and off-putting things about the weight-loss industry is the vague medicine promise. Have you considered just saying "semaglutide" instead of "a breakthrough medication"? I honestly almost stopped reading because it comes off as so huckster-ish to me.

[rich-cartwright]

I think a lot about our framing and I know for sure we haven't nailed it yet.

It's fair to say your avg HN reader is very different to your avg American. For example, you seem already somewhat clued up about Semaglutide. You're likely interested in the biology behind it, and probably aren't afraid to parse the journal article about it.

I really wanna emphasize how different this is to your avg American.

So it's more my bad for not tailoring our language enough for a HN post.

[bradknowles]

And this medication is already approved by the FDA for those of us who are diabetic. At higher doses, even.

They’re just taking the same medication and using it at lower doses for weight loss instead of diabetes control.

And frankly, as a fat diabetic, I strongly suspect it’s doing the exact same thing in both cases, and the reason it works for diabetics is that it helps them lose weight.

It’s definitely on my list to discuss with my endocrinologist.

[midjji]

Or medicines which have really long and strong evidence for weight loss effects like amphetamines?

[mitchellst]

Wow. This is really interesting and important. I’m not your target customer and don’t know a ton about health tech, so I’m not sure I can help you, but I wish I could. thank you for taking this on. Someone should. Sometimes the science and medicine is there but branding, marketing, and positioning in a bigger value prop aren’t things that doctors and hospitals are prepared to handle at scale. So, this is cool.

I do know one thing about your space, from pure happenstance. I live in Texas and my wife is a fourth-year medical student here. One of her profs is a bariatric surgeon and she spent time in his clinic. One of the interesting things she learned was the correlation between weight loss for one adult and weight loss of a household. I don’t remember the exact stats, but this doc would have whole families weigh in at his clinic, before and after. The results were astounding. The person who got the surgery would often lose only the plurality of the weight, and sometimes not even that. It’s something to consider messaging around as you target men and try to get through the stigma to persuade them to seek treatment. You are doing something good for your family; this is about more than just you. Texan men in particular are likely to hold more traditional values about being the head of their household, however unfashionable that may be. Help these fellas— and help their families.

[rich-cartwright]

Thanks man. Just so I've fully understood here:

> "The person who got the surgery would often lose only the plurality of the weight, and sometimes not even that."

By this you're meaning the whole family lost weight after one individual had bariatric surgery?

[ryanSrich]

Do you help people account for family lifestyles and cooking for more than just themselves? I used to do 2-3 day fasts, but now that I’m married with kids I find it almost impossible to do so since I cook and prep all the meals.

I tried low carb and keto. It works fine for me, but selling my wife on a breakfast that consists of 6 eggs and a pound of bacon is a hard sell. So there’s always bread and pasta in the house, which makes it harder to resist.

[MagicWishMonkey]

My wife is lifelong vegetarian, and I'm a big fan of keto. We've basically adapted to a "I make food for myself, she makes food for herself and we split responsibility for making food for the kids" workflow and it works out pretty well.

It helps a lot that I do the grocery shopping, I try to avoid buying stuff that I'll be too tempted by - like regular carb tortillas or plain tortilla chips.

[rich-cartwright]

Yep really good point about the family dynamics - lots of the Fellas talk about how having teenage kids around makes the dietary side really tough.

How the coaching works in the program is that we dive in at the start to really understand the 1-3 key leverage points where we can make the most impact - then focus all our coaching time on these.

[tarr11]

I tried Noom twice. I was the only man in the support group both times. It didn’t really speak to me or work for me.

Definitely interested in this!

[rich-cartwright]

We've heard this a lot..

[diskzero]

I am glad to see this. I was involved in a similar startup that became bogged down due to reasons that had nothing to do with the validity of the approach you are taking.

As I am sure you are aware, obesity is a complex issue and many of the suggestions sufferers get such as eat less, exercise more, try fasting, go keto, etc. are simply not helpful in and of themselves. Neither is just prescribing the latest medications without other forms of support.

I hope your concept of telehealth, medical supervision and personal coaching is one that will get results. Obesity is a serious issue that is robbing society of people and potential.

[senojretep356]

Agree - I think psychology is everything. It's odd that drinking too much and drugs is always put down to trauma, stress, and psychological treatment is seen as number 1, whereas with food addiction - it's often ignored to the very last.

People can argue until they're blue in the face but if you eat less calories than you burn you will lose weight. The problem is people with trauma plus a food addiction are not able to do this.

Is there any research around where you live and propensity for morbid obesity - especially living by the sea? I could only find one study which did support this theory but it was in the UK. I live in Bondi Beach where socialising is essentially exercising - surfing, swimming, kayaking etc etc and anecdotally I don't think I've ever seen a morbidly obese person in over 30 years (I know this sounds ridiculous and maybe it's because they never leave the house but it's true).

[rich-cartwright]

Thank you very much for this. Kind message.

What was the previous startup by the way? Always interested in improving my knowledge of the space!

[Eextra953]

Great Idea!I checked out the website and it looks like it is targeted towards older men (40+). Was there any particular reasoning for this? I'm in my 20s and I know a lot of men my age who are obese. Was the program developed specifically for older men?

[rich-cartwright]

Really good question. In our customer dev, we tended to find the older guys were a more motivated initial audience because health concerns are more top of mind. Plus there's still a lot of hesitancy & stigma around medication for obesity, but the older guys are more ready to take that step.

Fella works just as well for younger guys. Any more questions I can answer?

[deberon]

As somebody who has lost and gained weight a couple times, I can confidently say that losing weight on it’s own is hard. Really hard. I’ve had far more success deliberately changing my entire lifestyle and outlook on life. For me, it had to be a part of a wholistic health regimen. This included therapy, healthy eating, regular exercise, proper sleep, and a good balance of recreational activities (it’s important to have fun!). As somebody with chronic sleep problems, it’s been interesting seeing how unhealthiness in one aspect of life (sleep in my case) can affect other areas of my life (my weight). It’s hard to quantify this line of thinking, because in the end, all I did was eat less and exercise more to lose the weight. That advice isn’t terribly helpful. Then again, it’s very likely that “just be healthier” is just as unhelpful ;)

I will say, don’t be too hard on yourself. My stress eating would spiral (and still does!) when I get too hard on myself. Set small goals and objectives (no eating after dark, be mindful of what you put on your plate, no second helpings, etc) because completing these always feels good.

[rich-cartwright]

Well written. These are all core aspects of our coaching program to improve metabolic health: improve sleep, reduce stress, more pleasurable activities, better food choices, sustainable exercise routine, reasonable portion sizes.

The "small goals" is also critical to counter all-or-nothing thinking. We use a mix of behavioral & cognitive approaches to try to cement the improved habits & ways of thinking.

[criticaltinker]

Interesting offering, definitely an important market.

> So we started researching effective, evidence-based treatments for obesity

Fasting has a tremendous amount science supporting it [1], can you articulate why you're pursuing the prescribed semaglutide approach instead?

[1] Fasting: Molecular Mechanisms and Clinical Applications https://www.sciencedirect.com/science/article/pii/S155041311...

[dlevine]

I have done just about everything over the years to lose weight. I tend to exercise a ton naturally, so it has been more about eating less than exercising more. I would say that my natural weight is slightly overweight but not obese.

I've tried various brands of keto (Atkins/4 Hour Body), Weight Watchers, eating slowly, cutting out sugar and wheat, juice fasts. Everything has worked for a time, but the weight has eventually crept back. I have really good willpower, but I've read the research on willpower being a resource that you use up, and definitely agree with it.

For the past couple of months I have been on Noom. I have stuck to it, and I'm now thinner than I have been in a long time, but I'm a little bit skeptical that it's going to last long-term. But I'm getting married in less than 2 months, so I only need to stay where I am until the wedding, and then I can gain a few pounds.

[criticaltinker]

> I've read the research on willpower being a resource that you use up, and definitely agree with it

I don't enjoy subjecting you to cognitive dissonance here...but some highly cited research shows this belief may be a self fulfilling prophecy.

> Study 1 found that individual differences in lay theories about willpower moderate ego-depletion effects: People who viewed the capacity for self-control as not limited did not show diminished self-control after a depleting experience. [1]

> Study 2 replicated the effect, manipulating lay theories about willpower. [1]

> Study 3 addressed questions about the mechanism underlying the effect. [1]

> Study 4, a longitudinal field study, found that theories about willpower predict change in eating behavior, procrastination, and self-regulated goal striving in depleting circumstances. [1]

> Taken together, the findings suggest that reduced self-control after a depleting task or during demanding periods may reflect people’s beliefs about the availability of willpower rather than true resource depletion. [1]

[1] Ego Depletion—Is It All in Your Head? Implicit Theories About Willpower Affect Self-Regulation http://icelab.psych.uw.edu.pl/wp-content/uploads/2016/02/job...

[2] Beliefs about willpower determine the impact of glucose on self-control https://www.pnas.org/content/pnas/110/37/14837.full.pdf

[rich-cartwright]

"so I only need to stay where I am until the wedding, and then I can gain a few pounds" - this is interesting

[watwut]

Is it possible that you are at healthy weight for you? Because given lifestyle you described, it is quite possible.

[gnicholas]

It sounds like the medication is an important part of this plan. Is it something that you anticipate someone would take indefinitely, or only to get down to a target weight?

Also, can you give some ELI5 background on how the medication works in the body?

[criticaltinker]

> Semaglutide, sold under the brand name Ozempic among others, is an anti-diabetic medication used for the treatment of type 2 diabetes and chronic weight management. [1]

> Semaglutide acts like human glucagon-like peptide-1 (GLP-1) such that it increases insulin secretion, thereby increasing sugar metabolism. It is distributed as a metered subcutaneous injection in a prefilled pen or as an oral form. One of its advantages over other antidiabetic drugs is that it has a long duration of action, thus, only once-a-week injection is sufficient. [1]

> Side effects including nausea, vomiting, diarrhea, abdominal pain, and constipation may occur. In people with heart problems, it can cause damage to the back of the eye (retinopathy). Side effects include kidney problems, diabetic retinopathy, allergic reactions, low blood sugar, and pancreatitis. [1]

> Warning: Risk of Thyroid C-Cell Tumors - In rodents semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether semaglutide causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined. [2]

[1] https://en.wikipedia.org/wiki/Semaglutide

[2] https://www.drugs.com/sfx/semaglutide-side-effects.html

[lharries]

(Richie's co-founder here)

> ELI5 for how it works in the body:

GLP-1 RAs such as Semaglutide are increasingly looking like the best class of medication for weight management [1]

GLP-1 RA = Glucagon-like peptide 1 receptor agonist.

These medications stimulates a receptor in your body which results in a reduction in body weight and three main effects: 1 - Slowing down gastric emptying so food stays in your stomach for longer (this is thought to be why there is sometimes nausea when starting the medication) 2 - Making you feel full by working on your central nervous system 3 - Managing glucose control (which is why it's used for people with diabetes too)

[1] gives you a great summary of the field up to now and how it works.

> Is it something that you anticipate someone would take indefinitely, or only to get down to a target weight?

This will depend on the person, whether they are also diabetic and how much weight they have to lose and is decided through a conversation with their obesity doctor. After around 12-months on these medications the weight loss plateaus (at an average of 15% body weight). If one stops the medication then but hasn't made any changes to their lifestyle they'll likely put the weight back on. But during the 12 months of the program we will be tackling the other factors with the coach: sleep, stress, nutrition. And so after the first year it might well make sense to reduce the medication or stop completely.

Let me know if you have any more questions.

[1] https://blogs.sciencemag.org/pipeline/archives/2021/02/15/gl...

[rich-cartwright]

It's better to think of the medication as more similar to other medications taken for chronic conditions (e.g. hypertension) than a quick fix magic pill.

The papers show consistent weight loss for ~52 weeks, then plateauing off onto 68 weeks. If you suddenly stop taking the medication, the weight creeps back on. The research therefore suggests you can likely slowly taper off the medication after year 1, but with medical supervision to ensure that doesn't lead to weight gain. This is also why improved mindset & habits are also important.

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

ELI5: increases satiety, decreases appetite.

[neom]

Looks like you're using a common and old Diabetes medication to control glucose, changing the regulation of appetite? I'm curious why this works best for men? Does it work in women?

[rich-cartwright]

Yep GLP-1 RAs are the gold-standard, if insurance coverage permits (because they are expensive if you have to pay out-of-pocket). The effect is roughly equal in men & women. The big breakthrough was the latest GLP-1 RA called Semaglutide, FDA approved in 2017 for diabetes and June 2021 for weight management. The main paper for that is here if you're interested:

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

[wxnx]

This is really interesting as someone who works as part of a group who takes products similar to this to market! Thank you for sharing.

You mentioned the medication is as effective in women as it is in men. While I understand men are underserved in this space and so I respect the decision to focus on that population on that basis, I'm curious if there are business elements to that decision as well? Would you ever expand to serving women, given that they seem to be a larger potential customer pool?

[rich-cartwright]

Sweet what's the group you're part of? Sounds interesting.

It's obviously a great question about the focus on men, and something we think a lot about.

My take: the whole industry is focused on women, and there are already cool companies taking a medication approach with branding clearly focused on women: https://www.joincalibrate.com/, https://joinfound.com/, https://www.formhealth.co/

I'm a fan of what these folks are doing. But you speak to any Fellas (our name for our customers!) and they know those programs aren't aimed at them. Every week we hear something like "I'm fed up of being the only guy in the group".

From a business side, the bet we're taking is that if we manage to crack the messaging/framing/branding for the male audience, that's a great business. Plus how men think about their health is drastically changing as concepts of masculinity change, so the potential customer pool is growing rapidly.

In terms of future expansion: we don't know yet. At least not for the coming few years - there are a lot of bigger guys out there we want to help (35 million men have obesity)!

[microtherion]

Over the last 4 years, I've brought my weight down from nearly 310lb to under 240lb using an approach that seems to resemble closely what you're describing here (Liraglutide / Semaglutide, combined with nutritional and psychological coaching).

At 50+, I had more or less given up on losing a significant amount of weight, but due to increasing mobility issues and a diabetes risk, I wanted to give it another shot, and I'm glad I did.

I think the right kind of coaching makes a lot of difference: I describe the clinic I'm going to (dazz.ch) as "Weight Loss for Rich Old People": Everybody is non-judgmental, it's accepted as a given that behavioral change is hard and that setbacks occur, and the focus is on motivating people to keep trying.

So I could see your approach having a good chance of working for people like me. I suspect that one important and tricky element will be to build a personal rapport between your clients and the coaching staff — important, because it adds an element of accountability to the weight loss (I've always felt I didn't want to disappoint my dietician); tricky, because ultimately you want your clients to be loyal to your company and not to the employees.

[rich-cartwright]

Really interesting, thanks for sharing.

[djshah]

My wife is a doctor specialized in obesity management and works in a hospital daily where patients come in with BMIs well over 40. Besides semaglutide, which isn’t availble in this part of the world yet, they also prescribe liraglutide.

I’d say that if someone is extremely obese, it’s unlikely they’ll be able to bring their weight down just through medication and counseling because most people lack the motivation or self-awareness to turn it into a lifestyle, which is KEY to keeping the weight off. In most cases, bariatric surgery would be their only option. It’s also very easy for folks to fall off the bandwagon while going on a weight loss journey - I’ve always had periods of being overweight to the point of obese since I was young and it’s been a yo-yo of getting fit and then slowly slumping back into being unhealthy over the years until I had the mental shift that it’s a lifestyle change. Getting people to this state through telemedicine may be difficult. It’s a hard space to be in but definitely one that will have an unending supply of patients due to the way the world eats these days. Let me know if I can help in any way. Best of luck!

[agentdrtran]

Semaglutide makes it a lot easier to eat healthy though, at least for me. When you aren't super hungry all the time it's easier to make healthier choices or just not eat at all.

[rich-cartwright]

Thank you for the support! Where in the world are you based btw? Always interested to follow the approvals of Semaglutide.

[ChemSpider]

The catch with this "wonder drug" semaglutide is: It has to be taken _life-long_, not just during a diet!

So when you are 30 now, you will be on medication for the next 40+ years. This is a long time.

=> Long term side effects are not known yet. In animal studies, semaglutide caused thyroid tumors or thyroid cancer. It is not known whether these effects would occur in people using regular doses.

[lharries]

(Richie's co-founder here)

> The catch with this "wonder drug" semaglutide is: It has to be taken _life-long_, not just during a diet!

This is why the coaching part of the program is so important.

Whether it's taken for a while or just for the first year will depend on the person, whether they are also diabetic and how much weight they have to lose. It's a personalized decision based on a conversation with their obesity doctor.

After around 12-months on these medications the weight loss plateaus (at an average of 15% body weight). If one stops the medication then but hasn't made any changes to their lifestyle they'll likely put the weight back on. But during the 12 months of the program we will be tackling the other factors with the coach: sleep, stress, nutrition. And so after the first year it might well make sense to reduce the medication or stop completely.

It's also likely we'll continue to see new medications and improvements with our understanding of obesity that makes being on this particular medication for 40+ years very unlikely.

> Long term side effects are not known yet. In animal studies, semaglutide caused thyroid tumors or thyroid cancer. It is not known whether these effects would occur in people using regular doses.

Semaglutide was FDA approved for diabetes in 2018 (3 years ago) and in June this year for weight management. It's part of a class of medication called GLP-1 RAs which operate in a similar way (they all stimulate the same GLP-1 receptor). Liraglutide is another common one that was approved by the FDA in 2010 (11 years ago) for diabetes (by the EU in 2009) and for weight management in 2014. So there is a 3 year of history with this particular medication and an 11 year history for this class of medication.

Here's more about the history of GLP-1s and other weight loss if you'd like: https://blogs.sciencemag.org/pipeline/archives/2021/02/15/gl...

It's worth noting that, as with any medication, there is a cost-benefit trade-off. In this case it will depend on someone's current weight, what they've tried in the past, and the risks of other conditions e.g. heart disease, diabetes, and their past medical history. Each person that joins Fella has an in-depth discussion about this with an independent obesity physician and is welcome to speak it through with their own PCP too.

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

[kkoppenhaver]

Would have loved to know you're only live in Texas before I went through the ~10 page survey about all my personal information.

[rich-cartwright]

Really sorry about this. We tried to make this clear in the post, but you're right we can definitely make this clearer on our website.

Before launching on HN we haven't had an non-Texas traffic so there are some bits we need to change to our infra!

[throwaway330935]

I'm currently working on losing weight and having a fair bit of success, largely because my wife is also extremely serious about it now. I'm basically feeding off her success, and supporting her is making it easier for me to make changes in my diet.

Over the last 2 months she's lost almost 30lbs, and I'm at over 20. Largely this has been serious changes in diet: Little to no carbs, basically a lot of grilled veggies, Soylent, protein drinks, yogurts, fruits... A little more exercise.

Really, the trick has been: She got a sleeve surgery a week ago, and for around 6 weeks before that she was basically on the reverse after-surgery diet to get used to it. And I've been kind of following her diet, though she encourages some tweaks to make sure I'm getting what I need. And this week when she's been just having a cup of broth a day, I've not been anywhere near that.

Short story long, She's on this path enforced by surgery. I want to support her, but I also want to use her journey to help me with my own. I'm fairly healthy, but want to make some activities easier, and I've been having some arthritis in my hips that make me want to ease their burden.

Fella sounds interesting as a way of further supporting my journey. Sounds like it's not available outside of TX, which I assume is related to "board certified". Also a little hard to tell what the final cost is going to be, $450/quarter plus whatever the drug is? I saw one of the other similar drugs on goodrx at $1K (a month? a quarter? Not sure), but looks like my insurance might cover it to the tune of ~$100. Boy, sure hope there's no tie to pancreatic cancer though. :-)

On the one hand, extra support might be nice. On the other hand, we've been going for 2 months and I'm about 20% of the way to my goal, and it hasn't been so hard, but I could also see it getting harder. I've previously lost almost double what I've lost so far, and then plateaued and gained it back over ~5 years. But now I have my wife going through it as well, so maybe it'll be different? Or maybe not...

At $250/mo for the program and drugs, it seems worth trying, but doesn't sound like it's even an option outside of Texas. Thoughts?

[rich-cartwright]

Okay all important context, thanks for this. Which state are you in?

If you drop me an email on [email protected], we'll talk it through

[ecf]

The only thing you need to beat obesity is exercise and reduced caloric intake.

The idea that entire companies can be started to wrap that fact in a neat little package for people makes me depressed.

> It leads to an average 15% decrease in body weight, efficacy close to bariatric surgery [3]. However, medication-assisted treatment for obesity is still stigmatized by family doctors and therefore hard to access.

This won’t lead to a healthier society, it will lead to a more wasteful and consumeristic one.

[rich-cartwright]

This is the same ineffective trope said repeatedly without grounding in practical solutions which help real people get to a healthier weight.

[paulocal]

How is the drug different than victoza or any of the other weight management drugs that are currently under investigation for causing pancreatic cancer?

[lharries]

(Richie's co-founder here)

Victoza is the brand name for Liraglutide. The drug we are primarily interested in is Semaglutide. Both Semaglutide and Liraglutide are GLP-1 receptor agonists.

It's worth doing your own research and consulting a doctor but the experts I've spoken to (academics and clinicians) along with the studies state that: "GLP-1 analogues did not increase the risk for pancreatic cancer when compared to other treatments" (from a Nature Scientific Reports meta-analysis paper published in 2019) [1].

Here is the postmarket FDA safety information on Victoza if you are interested: https://www.fda.gov/drugs/postmarket-drug-safety-information...

[1] https://www.nature.com/articles/s41598-019-38956-2

[hnenbythrow]

I'm non-binary, assigned male at birth. I totally agree that having a program aimed at men and building supportive communities for men is important, as they are often under served by existing support infrastructures.

I'm curious if you'd consider non-binary folks as well? Should I not sign up if I'm nonbinary? Or even anyone who is ok with a 'primarily for men' atmosphere?

[rich-cartwright]

You're 100% welcome here. Would love it if you wanted to sign up.

Or if easier, you can drop me an email on [email protected] and we'll sort you!