Pharmacy Course Addresses Specific Challenges of Transgender Community

A course at Shenandoah University aims to increase pharmacists’ knowledge about gender identity and the unique health care challenges of transgender patients.

According to Jonn Bailey, assistant professor of pharmacy practice at the university’s Inova Center for Personalized Health in Fairfax, Virginia, an unmet need led him to introduce a focus on transgender care into the existing curriculum.

A member of the LBGTQ community and an advocate with the National Center for Transgender Equality,¹ he said that some transgender patients opt not to seek medical care, because of a lack of empathy and understanding from care providers about their needs.

“This is pretty widespread,” Bailey said in an interview.

“You have to change your way of thinking about the patient," he said. "Where is this person in their gender affirmation?”

As an example, Bailey described a transgender male with a urinary tract infection (UTI) whose provider refused to listen to why it might be necessary to explore treatment for the condition.

In this case, the patient still has female genitalia and was more likely to be diagnosed with a UTI than if he had male genitalia.

“We base a lot of our care on what we see walking into the room. This can create an uncomfortable situation,” Bailey said.

“You may have a transgender female who needs a prostate exam," he said.

In pharmacies, transgender patients who are picking up hormone therapies have reported pharmacists questioning the need for a medication.

In some cases, the pharmacists have been confrontational and vocal, Bailey said.

As a result, patients can be outed to other customers in the pharmacy.

“I see this in community and retail pharmacy all the time. There really is no patient privacy,” Bailey said.

However, he said that he sees ways that progress can be made in building comfort and trust between transgender individuals and health care professionals. His course aims to instill in students these practices:

• Ask about and understand a patient’s goals for gender-affirming identify. Not all transgender patients are looking for 100% gender affirmation, Bailey said.
• Ensure that the environment supports all gender identities. A simple sign or having an available restroom for transgender patients can help.
• Medical settings should have systems in place that document a person’s sex, gender identity, and where the person is in their affirmation process.
• Medical staff members should be trained about how to communicate effectively with transgender patients. Ask, ‘what is your preferred pronoun?’ and be respectful,” Bailey said.

In his 2-part course, he said that he uses the first semester to build empathy for transgender patients and to emphasize the need for comfort and trust. In the second semester, the course focuses more on the medical challenges specific to the transgender community.

By better understanding the transgender community, health care providers can improve patient outcomes.

The rates of human immunodeficiency virus infection and injection drug use are often higher among the transgender population, according to Shenandoah University.

Meanwhile, avoiding medical screenings and appropriate treatments can contribute to poorer health outcomes.¹

Bailey started working on the course about 3 years ago, after arriving at Shenandoah University from Xavier University of Louisiana College of Pharmacy in New Orleans. At the time, the course included other special population groups but did not address the transgender community.

He said that he did not wait for Shenandoah University to approve inclusion of transgender issues, but the topic has been well-received.

“I just did it and incorporated it,” Bailey said. “The university has been very inclusive of the transgender community.”

Thus far, Bailey has had 2 groups of students who have taken both parts of the course, and 1 has completed the empathy portion.

The curriculum is making a positive impact on many of these students, some of whom had previously worked with medical providers that displayed confusion with transgender patients, he said.

Feedback on the course has mostly been positive, Bailey said.

However, a small number of students have expressed discomfort with the curriculum focus on transgender patients.

“It’s very difficult, initially, for them to wrap their brains around,” Bailey said. “It’s still an area that people are learning about.”

Overall in health care, more actions are being taken to better address the challenges specific to the transgender community. In addition to the course at Shenandoah University, 2 other entities recently announced new programming geared toward these patients.^2-3

In Minneapolis, the Children’s Minnesota pediatric health system said this month that it is launching a multidisciplinary Gender Health Program to provide comprehensive care for youth who identify as gender-diverse or transgender.²

And in March, Backpack Health, a digital tools provider that offers resources for managing health, said that it is launching a dedicated group for nonbinary and transgender people within the company’s health data management platform.³

References

• A new curriculum in transgender care. Shenandoah University News. November 27, 2018. su.edu/blog/2018/11/a-new-curriculum/. Accessed April 15, 2019.
• Children’s Minnesota launches multidisciplinary Gender Health Program for transgender and gender-diverse youth [news release]. Minneapolis, MN; April 2, 2019: Children's Minnesota website. childrensmn.org/2019/04/02/childrens-minnesota-launches-multidisciplinary-gender-health-program-transgender-gender-diverse-youth/. Accessed April 19, 2019.
• Addressing health access challenges for transgender and non-binary community, Backpack Health establishes dedicated group on its health data management platform [news release]. Dover, MA; March 26, 2019: Backpack Health. prnewswire.com/news-releases/addressing-health-access-challenges-for-transgender-and-non-binary-community-backpack-health-establishes-dedicated-group-on-its-health-data-management-platform-300817629.html. Accessed April 19, 2019.