About 1.4 million Americans identify as transgender (TG) or gender non-conforming. For many of these patients, pharmacotherapy is a part of their gender-affirming transition. Yet, research shows that transgender patients face significant barriers in obtaining healthcare, which can delay treatment and complicate existing conditions. Although pharmacists serve as an important link in providing necessary healthcare, many may not feel confident about dispensing care to transgender patients. Education is key.
The American Psychological Association defines transgender as “an umbrella term for persons whose gender identity, gender expression or behavior does not conform to that typically associated with the sex to which they were assigned at birth.”
“At birth, individuals are identified with a biological sex based on their reproductive organs, whereas gender identity refers to one’s self-identification of being a man or woman or non-binary (neither a man nor a woman),” says Cheyenne Newsome, PharmD, clinical assistant professor in the department of pharmacotherapy at Washington State University’s College of Pharmacy and Pharmaceutical Sciences. “Specifically, the term transgender is used to define people who identify with any gender that is different from their biological sex at birth.”
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Already feeling at odds with a body that does not reflect their identity, transgender patients may face daunting difficulties accessing healthcare. A 2015 U.S. Transgender Survey reported that a third of all transgender individuals who had recently seen a healthcare professional experienced harassment, denial of care, or problems getting reimbursed by their health insurance. Fearing mistreatment, transgender patients may delay getting treatment when they are sick or injured or put off getting necessary preventive care.
Financial challenges may also be a factor, with 50% of transgender persons estimated to earn less than 100% of the federal poverty level and at least 33% being on Medicaid. The 2015 U.S. Transgender Survey found the unemployment rate among transgender individuals to be 15%, three times higher than the national average, which is likely due to discrimination based on their gender identity.
“Many transgender individuals who seek care do not believe that they can receive or afford adequate services for their health, yet they often have pressing health issues that are unresolved,” says Newsome.
According to Michael W. Jann, PharmD, professor of pharmacotherapy at University of Northern Texas System College of Pharmacy, a multidisciplinary care model should include: primary care, family planning, medical procedures, HIV and STD care, medical subspecialties, behavioral health, speech therapy, dentistry, optometry, and community and clinical pharmacy services.
“Transition is a complex and individualized process to help the person transform their physical appearance to match their gender identity,” says Jann. “The time for maximal effects of antiandrogen and estrogen therapy may take as long as three years while testosterone treatments take five years with consistent usage.
Aside from the complex process of transition, transgender patients also need preventive services as well as treatment for various medical conditions. Hypertension, obesity, diabetes, heart disease, and dyslipidemia are also common medical conditions occurring with transgender persons and can be more complicated with long-term hormonal therapies.
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