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Pharmacists Serve as Trusted Providers of Transgender Care

Ajay Patel, Pharm.D., and Hyojin Sung, Pharm.D., discuss alternative hormone formulations for a patient who no longer wanted to use injectable hormones.

WHEN IT COMES TO CARING FOR TRANSGENDER INDIVIDUALS, placing a rainbow flag in the pharmacy and using an individual’s preferred pronoun may be as significant as providing good clinical care. Experts say these measures help ensure that the underserved transgender population receives the healthcare they need.

“Transgender patients can have a lot of fear around seeking care because of societal stigmas and experiences of discrimination,” said Bryan Bishop, Pharm.D., BCPS, Assistant Professor in the Department of Pharmacy Practice at the University of Toledo College of Pharmacy and Pharmaceutical Sciences in Toledo, Ohio.

The transgender community is growing rapidly, with a 2016 survey estimating the population at 1.4 million — twice what it was a decade ago, according to the Williams Institute. Similarly, the number of transgender individuals seeking medical care is growing exponentially, as noted in a study in the Journal of Urban Health.

With this surge in numbers, pharmacists need to know the unique needs of the transgender population. One of the most important is to feel safe and welcome in a space, said Dr. Bishop. “Being friendly, showing empathy, and using patient-preferred names and pronouns are some of the best things pharmacists can do when interacting with transgender individuals,” he advised.

Health Disparities
As the Human Rights Campaign reports, transgender populations have more healthcare needs than the general population. For example, transgender people are 68% more likely to smoke, and rates of substance abuse are up to fivefold higher. The prevalence of anxiety and depression is more than twice as high in the transgender population, and the risk of attempted suicides is also higher.

Jessica Conklin, Pharm.D., Ph.C., AAHIVP, BCACP, CDE

Pharmacists have a role in screening transgender patients and referring them to the right providers, but pharmacists also have a good opportunity to address the health needs of transgender individuals directly, said Jessica Conklin, Pharm.D., Ph.C., AAHIVP, BCACP, CDE, Assistant Professor in the Departments of Pharmacy Practice and Administrative Sciences at the University of New Mexico in Albuquerque.

“We are uniquely placed to help patients with a variety of health needs,” she said, “for example by providing smoking cessation and lifestyle counseling to reduce the risk of cardiovascular complications of hormone therapy or to help promote weight management, since obesity can be an adverse effect of hormone therapy.”

Dr. Conklin takes on a variety of roles as a clinician at the Truman Health Services Clinic, a multidisciplinary medical home affiliated with the University of New Mexico. She collaborates with patients to establish treatment goals and sets out treatment timelines. She also has in-depth discussions with patients about the risks and benefits of hormone therapy, both medical and social.

“It’s important to talk about the possibility of losing housing and employment, and experiencing changes in family dynamics,” Dr. Conklin said. “We can be a huge support to our transgender patients and make sure they are treated as a whole person during their care process.”

Insurance issues can present barriers to care among those who do have coverage, Dr. Conklin explained. “For example, standards of care recommend using GnRH [gonadotropin-releasing hormone], but many of these are not covered, or are only covered under certain conditions,” she said. “I do a lot of work educating insurance companies to help get those covered.”

Dr. Conklin also helps patient obtain prior authorizations, orders and interprets laboratory tests, identifies comorbidities that need to be addressed, and assesses barriers to care.

Education Lacking
According to Ajay Patel, Pharm.D., the cornerstone of transgender healthcare is most often, although not always, gender-confirming hormone and non-hormonal therapies. However, he added that the likelihood a pharmacist will be familiar with these treatments is low, since most pharmacy schools do not include transgender care in their curriculum.

Ajay Patel, Pharm.D.

“If pharmacists want to bridge gaps in care and provide comprehensive and whole-person care for transgender patients, we first need to be educated in transgender health,” explained Dr. Patel, Pharmacy Associate at the University of Minnesota/Community-University Health Care Center in Minneapolis. Topics in transgender care have a place in a variety of educational areas, such as endocrine pharmacotherapeutics, drug delivery, and pharmacokinetics, he added.

The scant numbers of pharmacy students who do receive in-class education on transgender care have few placement opportunities in clinics that specialize in transgender populations, Dr. Conklin noted. The medical home where she practices is one of those rare places. “Our students participate in interprofessional clinic sessions, topic discussions, and drug information reviews, and are taught how to collect patient information and provide patient education to this sensitive population, as well as how to collaborate with other providers,” Dr. Conklin said. Such real-world experiences are invaluable, offering pharmacists something they cannot learn in the classroom, she explained.

“I’ve developed a real sense of humility that I now bring to the care process,” she said. “I’ve come to understand that it’s ok to make mistakes, as long as you can learn from them.” Most importantly, Dr. Conklin said, she has learned to treat transgender individuals with great dignity and respect.

For additional resources on transgender and lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) health, visit the Human Rights Campaign (HRC), the nation’s largest LGBTQ civil rights organization. The HRC website includes information about providing LGBTQ services at your pharmacy and how pharmacists can support LGBTQ patients. More information can be found at the National Center for Transgender Equality and the National LGBT Health Education Center.

The February 1, 2017 issue AJHP includes several articles and an AJHP Voices podcast about providing pharmacy care to transgender persons.

By David Wild