5 Ways Pharmacists Can Help Transgender Patients

Transgender patients have unique health needs, but few health care professionals have received adequate training on how to best care for these patients.

Bryan Bishop, PharmD, BCPS, clinical assistant professor at the University of Toledo College of Pharmacy and Pharmaceutical Sciences, recently wrote about pharmacotherapy considerations in the management of transgender patients in Pharmacotherapy.

Dr. Bishop told Pharmacy Times that he believes education on transgender patients warrants inclusion in diversity training at pharmacy schools and should also be a part of all health care professionals’ training.

In his review of pharmacotherapy considerations, Dr. Bishop noted that around 1 in 100,000 Americans are transgender women, and the number of transgender men is estimated at around 1 in 400,000. However, both of these figures are likely conservative.

Pharmacists who are interested in or specially trained in endocrinology and transgender health can get more involved in the care of these patients through counseling, medication therapy recommendations, dose adjustments, and adverse reaction management.

Here are 5 ways pharmacists can help transgender patients.

1. Direct transgender patients to the best available resources.

Dr. Bishop maintains this is the best way pharmacists can advocate for transgender patients. In terms of insurance, pharmacists can help coordinate care among the physician, pharmacy, and insurance company as best as possible.

“Within health care systems, providing education to staff—particularly on interactions with patients—is the best way to advocate,” Dr. Bishop said. “Having an inclusive, welcoming pharmacy or health care system is one of the best ways to advocate for transgender health care in my opinion.”

2. Start a conversation.

Pharmacists should be sensitive about patients’ preferred gender identity, names, and pronouns. Dr. Bishop told Pharmacy Times that pharmacists should keep lines of communication open and use gender-inclusive terms when applicable.

He also pointed to a study published in the Journal of Clinical Nursing that showed it was appropriate for health care providers to ask for the name and pronouns that patients prefer. Some patients may not want to use “him” or “her” and would rather be called by their names or nongendered pronouns like “they.”

3. Know the increased risks for transgender patients.

Pharmacists should know that transgender patients face increased risks for suicide attempts and tobacco, alcohol, and substance abuse. They are also more likely to experience significant stressors such as violence, discrimination, and abuse.

In addition, pharmacists should know the patient’s biologic sex so that they can perform calculations for creatinine clearance and prevent those who are capable of getting pregnant from taking teratogenic agents, Dr. Bishop noted in his study.

These considerations may be tricky when using electronic health records (EHRs). For example, EHRs might automatically perform calculations for things like creatinine clearance.

“Pharmacists, in particular, need to have an accurate creatinine clearance because dosing protocols are predicated on this value, and the pharmacist managing the dosing may not see the patient or read deeply enough into patients’ chart to know that they are transgender patients and that the creatinine

clearance needs to be recalculated,” Dr. Bishop pointed out.

Another consideration is the risk for HIV.

One meta-analysis showed that almost 20% of transgender women have HIV. In addition, a US Centers for Disease Control and Prevention study found that almost 75% of HIV-positive transgender women were unaware of their HIV-positive status.

4. Identify barriers to care.

Dr. Bishop’s research cited a study that found 21% of transgender patients do not go to the emergency department because they fear their transgender status could negatively affect the encounter.

Some patients may not seek care because of worries of being “outed” if they do not publicly recognize their transgender status. In general, lesbian, gay, bisexual, and transgender patients are less likely to have health insurance, as well.

In addition, institutional stigma may negatively impact patients’ regarding insurance, visitation rights, and proxies for health care decision-making.

5. Help transgender patients and their families understand their medications.

“Pharmacists can and should be an essential member of health care teams providing medical treatment to transgender patients,” Dr. Bishop wrote in his study.

Particularly, pharmacists can help patients understand the medications used in puberty suppression and/or transition therapy. For patients with male sex organs, puberty suppression is achieved through gonadotropin-releasing hormone (GnRH) analogs, which work to stop the secretion of testosterone.

“In the case of GnRH analogs, pharmacists and pharmacy technicians can help patients with acquiring medication and advocate for patients, either with their insurance companies or within health care systems,” Dr. Bishop advised.

In addition, pharmacists can help inform and recognize when transgender patients are having adverse drug reactions associated with these medications and provide therapy recommendations if possible. Dr. Bishop also noted that pharmacists can help set expectations for patients regarding when changes should start to occur and how much of an effect they might experience from the medications.

“It is important for pharmacists to understand the care of transgender patients if they are to provide culturally sensitive care to their transgender patients,” Dr. Bishop said. “By providing culturally sensitive care, pharmacists can help promote engagement and acceptance of transgender patients in health care systems.”