Everything you need to know about transgender healthcare

Locum pharmacist Alexis Jensen (she/her), who is undergoing feminising treatment, sat down with Australian Pharmacist to discuss how to provide, inclusive, safe and clinically appropriate care.

1. What’s your experience as a transgender pharmacist and patient?

I came out in November 2021, and started treatment on 8 March 2022 (International Women’s Day). The support from family, friends, colleagues and patients has been absolutely mindblowing. 

Having a secret identity, however, does lead to some ‘interesting’ situations. For example, my authority as a pharmacist and manager was never questioned while male presenting. On one locum assignment, however, a coworker was concerned whether they could work with me but then decided I was ‘alright’. 

I’ve been outed by cluey patients in front of coworkers I hadn’t told and misgendered by coworkers to patients. I’ve also been asked to comment on other trans peoples’ appearances. 

I receive a lot of unwanted attention, prying questions and misgendering when I get discovered, which is why I normally don’t tell acquaintances.

2. How can pharmacists best provide inclusive care to transgender patients?

The best approach is to remember there is a human on the other side of the counter. 

Not all transgender, non-binary and gender-diverse people can, or want to, take hormones or pursue surgery. Gender expression does not necessarily equate with gender identity, and everyone’s transition goals are different.

To ensure your pharmacy is an inviting and inclusive space, use gender-neutral and inclusive language. Rather than saying ‘the woman’, for example, you could say, ‘the person with the hat’.

Small personal touches can help patients identify your pharmacy as a safe space. When I locum, my name badge and plaque have rainbows on them, which creates an instant bond with many people. 

Using social media can help the LGBTQIA+ community feel less isolated, with Reddit, Facebook, Instagram, Twitter, TikTok, and Discord the main platforms of choice. 

At the same time, your LGBTQIA+ patients may feel specifically targeted on those platforms, so your pharmacy’s social media team could post a rainbow to show support.

But remember, it’s equally important to know where the line is. If you’re overzealous, it may come across as pandering or disingenuous.

If you accidentally misgender someone or use the wrong name, immediately apologise, correct yourself and let them know it will never happen again. There is no need to make excuses or long apologies.

3. How can pharmacists avoid dispensing mishaps?

It’s important not to refer to transgender patients by their deadname, even when referencing past events.

It makes you feel unsafe, unappreciated, or that people are just not paying attention, plus it can also place patients at risk of anti-trans harassment.

This can be tricky at times, as prescriptions may still come in a patient’s deadname, and new staff and locums may be unaware of their chosen name. 

In these situations, I always create a blank profile under the patients’ deadname and make pop-ups with instructions to dispense under the new name.

Most dispensing software allows you to set a different name for patients that can be printed on labels and repeats, with a separate spot for Medicare details for claiming. 

‘I‘ve been outed by cluey patients in front of coworkers I hadn’t told and misgendered by coworkers to patients.’

ALEXIS JENSEN

This can be amended if the patient notifies you of their legal name change, but bear in mind that MedAdvisor, Dose Administration Aid (DAA) or any other third party software will also need to be updated. 

Scanned scripts and e-scripts might inadvertently repopulate those fields with old information, so be vigilant and delete as necessary.

While gender markers must officially remain unchanged until updated in Medicare records, there are ways to sensitively approach this with the patient.

You could say: ‘I apologise, but I need to keep birth gender markers unchanged for the purposes of Medicare claiming until I’ve been informed of a change. Please be assured that I have your gender recorded accurately elsewhere. Would you be so kind as to let me know when this change happens?’

4. What are some key clinical considerations about gender affirming medicines?

There is often confusion about who these medicines are for and the conditions they’re prescribed to treat.

Pharmacists might assume feminising hormones are for a cis partner or relative, for example, or spironolactone might be confused as treatment for heart failure, resistant high blood pressure, primary aldosteronism or hirsutism. 

It could also be assumed that patients prescribed bicalutamide and cyproterone are undergoing treatment for prostate cancer.

When in doubt, always take the patient aside to inquire who the medicine is for and the indication. You should also confirm the dose and thank them afterwards.

It’s also important to consider how hormone treatments interact with other medicines. If a patient taking spironolactone presents with a urinary tract infection, for example, co-administration of trimethoprim can result in additive hyperkalaemia. In that event, both nitrofurantoin or cephalexin are suitable alternatives. 

When it comes to birth control, the usual considerations based on sex assigned at birth still apply. It’s important to inform patients that testosterone alone or lack of a period is not an effective form of contraception for patients with a uterus, for example.

If emergency contraception is needed, pharmacists should inform patients that levonorgestrel or ulipristal will not cause feminisation or interruption to therapy.

5. How can I upskill to provide the best possible care to my transgender patients?

There are plenty of electronic resources out there to help pharmacists learn more about providing care to their transgender patients, including the PSA CPD Providing healthcare for the transgender and gender diverse and online module Trans and gender diverse healthcare in pharmacy.

A great ‘Trans for Dummies’ resource is ACON’s TransHub, which I refer to frequently when speaking with my colleagues, patients, friends, family, and support workers. My go-to Transhub resource is 10 tips for clinicians working with trans & gender diverse people. 

For clinical care, Thorne Harbour Health has a Hormone Therapy Prescribing Guide for GPs working with trans, gender diverse and non-binary patients, which is a quick handy reference for common medicines and doses.

To best support transgender patients, pharmacists also need to be aware of local referrals.

Make a list of local sexual health clinics, sexual health specialists, endocrinologists, and GPs who prescribe gender affirming therapy. Reach out to let them know your pharmacy is a safe place for sending their patients to, and that they can rely on you for assistance.

New funding for LGBTQIA+ community

In the midst of WorldPride 2023, the Federal Government announced a $26 million investment in health and medical research for the LGBTQIA+ community, along with a 10-year National Action Plan for the Health and Wellbeing of LGBTIQA+.

Minister for Health and Aged Care Mark Butler and Assistant Minister for Health and Aged Care Ged Kearney said the funding would address the specific health needs of the LGBTQIA+ Australians, who often face difficulty accessing care – leading to poor health outcomes.

‘As WorldPride celebrations continue in Sydney, there is no better time to demonstrate how committed this Government is to health equality,’ said Minister Butler.

For more information on providing care to your transgender patients, read PSA recent Equality position statement and complete Providing healthcare for the transgender and gender diverse CPD.