Pharmacists’ role in transgender healthcare: A scoping review

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Abstract

Background

Transgender patients have unique healthcare needs, providing pharmacists with the opportunity to play an important role in transgender care through addressing the healthcare disparities observed in this patient group.

Objective

This scoping review aimed to explore the role of pharmacists in transgender healthcare.

Methods

Six databases were searched from inception: Emcare, Informit, MEDLINE (Ovid), PubMed, Scopus, and Web of Science. The first author performed screening and data extraction in consensus with co-authors. Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was utilised to report this review. Themes related to the role of pharmacists in transgender healthcare were identified.

Results

A total of 356 studies were identified; however, only 15 studies, all from the USA met the selection criteria and were included in this review. Study types included empirical research, practice reports and opinion pieces such as commentaries, editorials, and reports. Pharmacists were found to practise in two different care settings: community and interdisciplinary clinics, performing various roles in transgender healthcare, including patient education and counselling, management of cross-sex hormonal therapy, patient advocacy and provision of preventative care. They were also responsible for the provision of culturally sensitive care in an inclusive and welcoming environment. Although pharmacists considered their role important, they lacked confidence in their knowledge to provide appropriate care to this patient group.

Conclusion

This review has highlighted that there is a need for education in transgender care for both pharmacists and pharmacy students, so that they are both confident and comfortable to play a meaningful role in transgender care. Pharmacists’ involvement in addressing the health disparities experienced will contribute to improving the overall health outcomes for this group.

Introduction

The term transgender (TG) is an umbrella term that encompasses individuals whose gender identity differs from their biological sex.1 In this review, the term TG refers to persons that identify as trans, transmen, transwomen, genderqueer, agender, gender fluid, non-binary, sistergirl or brotherboy. Although the exact numbers of the TG population are not available, it is estimated that approximately 0.1–2% of the population worldwide identifies as TG.2 With increasing social acceptance, many TG patients are accessing care for gender affirmation and other health issues.3

TG patients have diverse healthcare needs.4 The prevalence of mental health issues such as depression, anxiety and suicidal ideation is significantly higher compared to the general population.5, 6, 7, 8 A recent survey reported that approximately 56% of TG patients were diagnosed with depression, and 40% with anxiety.5 These patients are also more likely to engage in high-risk behaviours such as tobacco, alcohol and substance abuse, unprotected sex and needle sharing.6,9 The risk of developing HIV infection in TG women is 49 times higher than the general population.10 Approximately 78% of TG people desire hormonal treatment for gender affirmation; however, only 50% of them receive this therapy.6 It has been reported that between 23 and 71% of TG women procure hormones from a non-medical source and may use higher than the recommended dosage.11, 12, 13, 14 Although TG patients have these unique healthcare needs, some may be hesitant to access required care based on their previous experiences of discrimination and marginalisation emanating from the healthcare system.4,8,15 Many TG patients have reported that healthcare providers lack knowledge about TG care and in many instances, find themselves teaching these providers about TG care.7,16 A recent Australian survey of TG patients highlighted the need for improved access to healthcare and better training for healthcare professionals.4

Pharmacists, being highly accessible and trusted health professionals, may improve health outcomes for TG patients through their expert knowledge of healthcare issues and in collaboration with other healthcare professionals.6,17,18 This aligns with the Pharmaceutical Society of Australia (PSA) Competency Standards for Pharmacists that states pharmacists should collaborate and deliver culturally responsive, patient-centred care and promote the judicious use of medications for all patients.19 In addition, the Accreditation Standards for Pharmacy Programs in Australia and New Zealand require all pharmacy education programs to promote inclusive and responsive patient-centred care that respects cultural diversity and assures the safety of every patient.20 The increasing demand for TG care6 informed the aim of this review; to identify the pharmacists’ role, any barriers to care provision and training requirements for providing this care.

Section snippets

Method

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR).21

Results

A total of 15 studies describing interactions of pharmacists with TG patients were included in this scoping review. A variety of study types were found including empirical research23, 24, 25, 26, 27, 28 (n = 6, 40%), practice reports29, 30, 31 (n = 3, 20%), commentaries32, 33, 34 (n = 3, 20%), editorials35,36 (n = 2, 13%), and reports with opinions37 (n = 1, 7%). All studies (n = 15, 100%) originated in the United States of America (USA), with no studies from any other country, including

Discussion

This review was undertaken to map the role of pharmacists in TG healthcare. The 15 articles identified have relied only on US data, underlining a lack of studies from other countries, including Australia.

Pharmacists have been reported to play a significant role in TG healthcare and the role included patient education and counselling,24,26,27,29,31,32,34,35 management of CSHT,27,29,30,32, 33, 34, 35 and provision of preventative care services.24,31, 32, 33, 34, 35 Pharmacists have provided

Conclusion

This review indicates that the role pharmacists may play in TG healthcare is both complex and varied. Highlighted is the need for additional TG healthcare education in therapeutics as well as cultural sensitivity for pharmacists and pharmacy students. Such training would assist in delivering culturally responsive and patient-centred care as is envisaged by the Pharmaceutical Society of Australia's competency standards.19 TG healthcare education and training can be integrated into pharmacy

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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