How to support your transgender patients

It’s becoming increasingly common to interact with transgender individuals in the pharmacy. However, their unique healthcare needs are often unrecognized and unanswered. As pharmacists who may see these patients regularly, you can acknowledge their needs with increased sensitivity and awareness. That way, you can ensure all patients receive equal care and support.

Whether you’re dispensing hormonal therapies to transgender patients or counseling them on other healthcare concerns, you can do so respectfully to promote an inclusive environment. In many cases, these patients face barriers due to varying state laws. By collaborating with other healthcare professionals and being open to treating the needs of transgender patients, you can make great strides in providing better care.

Continue reading to learn more about strategies and tips for supporting transgender patients.

Key terms in transgender care

Knowing key terminology may help in better understanding the needs of transgender patients and providing effective care. If you’re familiar with some of these terms, you may be able to better communicate with transgender patients and help them feel recognized and supported.

• Affirmed gender: The gender that a person recognizes as their own, which can differ from the sex assigned at birth
• Cisgender: Individuals whose gender identity matches the sex they were assigned at birth
• Gender dysphoria: Discomfort or distress caused by a discrepancy between a person’s gender identity and their sex assigned at birth
• Gender nonconforming: A term describing people whose gender expression differs from the conventional ideas of masculinity and femininity
• Non-binary: A gender identity that is not exclusively male or female. Non-binary individuals may identify as being both genders, somewhere in between, or as falling completely outside these categories
• Transgender man: A person who was assigned female at birth but identifies and lives as a male
• Transgender woman: A person who was assigned male at birth but identifies and lives as a female
• Transition: The process by which transgender individuals start living as the gender with which they identify, which may include changing one’s name, pronouns, clothing, and possibly undergoing certain medical procedures

With these definitions, you can have a framework for how transgender individuals might experience the world around them. You can include this vocabulary in your daily practice to offer more inclusive and sensitive service to all patients.

Overview of hormone replacement therapy (HRT)

Hormone replacement therapy is a key part of gender-affirming medical care to align physical characteristics with gender identity for many transgender patients. It typically involves the administration of estrogen and anti-androgens in transgender women and nonbinary people, which can lead to changes such as breast development, softer skin, and redistribution of body fat.

For transgender men, HRT commonly includes testosterone, which encourages the development of male secondary sex characteristics, such as increased muscle mass, deeper voice, and facial hair growth. The medications may be administered through various methods like injections, patches, gels, or tablets, offering options tailored to different preferences and needs.

Healthcare providers should prescribe and monitor hormone replacement therapy while considering the patient’s overall health, desired effects, and possible side effects. The patient’s treatment plan can change over time based on lab work, physical changes, and personal goals. 

Treating transgender patients

When treating transgender patients, pharmacists may need to consider various factors of transgender care, such as pharmacokinetics and mental health support. By considering these elements, pharmacists can ensure patients get care tailored to their needs.

Consider pharmacokinetics

Body composition, including differences in body fat distribution, can influence how medications are metabolized in transgender individuals. For example, trans women may experience an increase in body fat and a decrease in muscle mass due to hormone therapy, potentially affecting drug absorption and distribution. Being aware of these changes can help with managing medication dosages accurately for each patient’s body.

Prioritize mental health

Transgender individuals may often experience significant mental health challenges due to societal pressures and discrimination. As a result, they may require medications to manage problems like anxiety and depression. It may be helpful to stay prepared for potential drug interactions or side effects these individuals might experience while taking antidepressants, anti-anxiety drugs, or other mental health medications.

In addition to these potential factors of care for transgender patients, you may want to think about creating a more inclusive pharmacy environment. After all, many of these patients might not seek care if they don’t feel welcome.

Create an inclusive pharmacy environment

There are various ways to create a safe and welcoming space in pharmacies for transgender and gender-diverse individuals. Pharmacists can help ensure their workplace is respectful and affirming to all patients by improving cultural competency and being sensitive toward gender diversity.

Creating an inclusive environment often involves training staff on gender sensitivity. Here are some strategies for pharmacy staff:

• Educate staff on the definitions and differences between sexual orientation, gender identity, gender expression, and sex assigned at birth.
• Have ongoing training that includes scenarios and role-playing exercises to handle situations with respect and professionalism.
• Regularly update staff on evolving best practices and guidelines for transgender health care.

In addition to training, pharmacists can develop strategies to communicate respectfully:

• Ask patients for their preferred names and pronouns at the start of service and include these in pharmacy records, ensuring all staff members use them consistently.
• Use gender-neutral language when addressing groups (for example, “everyone” or “folks”) and when discussing gender when the specifics are not known.
• Display signage that signals an inclusive space and can make transgender patients feel more welcome.

Creating an inclusive pharmacy environment is about delivering respectful, person-centered care and committing to the ongoing education of staff on gender diversity.

Recommend counseling and support

Pharmacists can help provide support and resources to transgender individuals. When working with transgender patients, you can prioritize open-ended questions that respect their experiences, such as inquiries about their support system and any needed clarification about hormone therapy and transition-related treatments.

Key areas of support for transgender patients may involve:

• Answering questions and concerns: Patients might have questions about HRT effects and protocols. Discuss potential changes and the importance of sticking to prescribed hormone treatment plans.
• Referring to specialized healthcare providers: If a patient requires services beyond your scope, offer referrals to healthcare professionals with expertise in transgender health.

Pharmacists can provide information on counseling services and support groups that specialize in transgender issues. Various groups, such as the Human Rights Campaign, the National Center for Transgender Equality, and OutCare, often provide more information and resources to patients. Let’s help them feel seen, heard, and supported throughout their healthcare journey.

Maintain privacy and confidentiality

Another aspect of transgender care is preserving the privacy and confidentiality of transgender patients. Patients may experience a fear of stigma or potential discrimination that can hinder their willingness to seek care. Safeguarding patient information not only adheres to legal requirements but also builds trust. Respecting a patient’s gender identity or history and keeping it confidential can help them feel secure and respected in a healthcare environment.

When handling patients’ personal records and sensitive information, here are a few best practices to follow:

• Secure storage: Keep all patient records in a secure location—whether physical or digital—and ensure they are only accessible to authorized personnel.
• Discretion in communication: Discuss transgender patients’ information only with individuals who require it to provide care and always in private settings.
• Patient consent: Never share details about a patient’s transgender identity or medical history without their explicit consent.

Always maintain clear communication and ensure patients understand their rights regarding privacy and confidentiality. This transparency helps prevent accidental breaches of trust and reinforces confidentiality in healthcare settings.

Assist with barriers to access

Transgender individuals may experience several hurdles when seeking health care, including discrimination and inadequate insurance coverage for necessary treatments. By recognizing these obstacles, pharmacists may be able to help improve healthcare access for transgender patients.

• Identifying common barriers: Pharmacists should be aware that transgender patients may face challenges in obtaining gender-affirming therapies due to structural barriers like the exclusion of transgender-related services in health plans.
• Insurance and medication challenges: Transgender patients may find it confusing to understand what is and isn’t covered by insurance. In many cases, insurers may deny coverage for hormones or surgeries, considering them cosmetic rather than medically necessary. Pharmacists can stay up-to-date on alternative coverage options or patient assistance programs that may help overcome these financial barriers.
• Pharmacist advocacy: Pharmacists can advocate for their transgender patients by staying informed about the current guidelines for transgender care and supporting inclusive insurance policies. They can also ensure their pharmacies are safe spaces that respect patients’ identities, which can include using correct pronouns and names and creating a discrimination-free zone.

Strategies for supporting access might also involve collaborating with healthcare providers to offer gender-affirming treatments or directing patients to supportive resources like transgender advocacy groups. In many cases, it may be a matter of provider education on transgender health issues and practical ways to offer sensitive and competent service.

Continuing education and awareness

Pharmacists can be a key resource for transgender patients seeking the appropriate care. Therefore, it’s important to keep up with ongoing education on transgender healthcare issues, which might include staying informed on the most current best practices, such as hormone therapy protocols. For example, you might participate in continuing medical education courses about transgender care throughout the year to stay up-to-date.

In addition, numerous professional development resources and organizations, such as the World Professional Association for Transgender Health and the Transgender Professional Association for Transgender Health, offer helpful information. These resources may help pharmacists develop a deeper cultural competence, which may decrease healthcare disparities for transgender patients.