Contraceptives, Gender-Affirming Care, and Other Hot Topics for Pharmacists


What is the state of OTC contraception, what’s next for IUDs, and why are so many transgender people denied care?

Karen M. Gunning, PharmD, BCACP, BCPS gave a presentation titled Women’s Health and Gender Affirming Care: Hot Topics for Pharmacistsat the ASHP Summer Meetings in Baltimore, in which she discussed the current state of contraceptives, and the future for them in pharmacy.

Pharmacist-Prescribed Contraception

Years ago, states started to pass laws allowing pharmacists to distribute self-administered hormonal contraceptives to patients, and now 27 states have a law doing so in some sense, though rules vary drastically state by state. “I would say that if you are moving between states, get introduced to the laws, because every state seems to be very different,” she said.

Gunning also explained why patients are developing more of a propensity for seeking out their pharmacists when they need contraceptives. “So, they have looked at why—why patients went to pharmacists who are providing the service—and it's somewhat predictable,” she said. “Patients couldn't get appointments; patients had no refills. Patients were very highly satisfied with the care that they got from pharmacists.”


Regarding intrauterine devices (IUDs), many versions are now approved for longer than they were originally approved for; Mirena and Lilleta are approved for 8 years of use, Kyleena is approved for 5 years, and Skyla is approved for 3 years, said Gunning.

Shealso discussed what could be coming next for IUDs; self-removal, understandably, was top of mind. “There's a whole chat and literature on self-removal. That’s not quite ready for primetime, but it’s something that's being looked at.”

OTC Contraception

The FDA still has to rule on Opill, a progestin-only contraceptive that could potentially be the first OTC birth control pill available in the United States. OTC contraception as a whole, says Gunning, is supported by multiple national physician organizations, but cost and insurance coverage are the big concerns and potential roadblocks.

Health Care for Transgender Individuals

Currently, health care for transgender individuals is deficient in many areas, and while some of that stems from the fact that research is ongoing, and we continue to learn best practices for treating trans people, some of it also stems from neglect or disinterestfrom the health care system to treat trans individuals, said Alex R. Mills, PharmD, BCACP, AAHIVP.

Mills continued the session by discussing health care for transgender individuals, specifically gender-affirming care. The latest data from the Human Rights Campaign shows 20 states have laws or policies banning gender-affirming care up to the age of 18 years and another 7 states are considering laws or policies banning gender-affirming care up to the age of 18 years.1 As a result, 31% of transgender youth live in states with bans and 13% are at risk of losing access to gender-affirming care.

The trans population is anywhere from 0.3% to 5.4% of the adult population and 2.5% to 8.4% of the children/adolescent population, based on self-reported surveys.

“One in 4 transgender individuals are denied coverage for gender affirming services or even routine care,” Mills said.

The numbers speak for themselves, he continued. When transgender individuals receive Gender Affirming Hormone Therapy (GAHT), there is a 78% improvement in psychological symptoms, and an 80% improvement in overall quality of life.

Overall, health care for transgender people “Doesn’t need to be as challenging as we think,” Mills said.

1. HRC Foundation. Map: attacks on gender affirming care by state. Human Rights Campaign. Updated June 1, 2023. Accessed June 13, 2023. 
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