Expert: Individualized Gender-Affirming Care and Support is Essential for LGBTQ+ Patients

For Pride Month, Pharmacy Times interviewed Olivia Buckoski, PharmD, AAHIVP, HIVPCP, clinical pharmacist, Western North Carolina Community Health Services, to discuss gender-affirming care for patients in the LGBTQ+ community, what it looks like, and the importance of catering care to the individual. This patient population often face stigma, a lack of cultural competency among providers, and discrimination; however, pharmacists and health care professionals can help by creating a supportive environment for patients.

Pharmacy Times: Can you introduce yourself?

Olivia Buckoski: My name is Olivia Backoski, and I'm a pharmacist in Western North Carolina, I work at an FQHC which focuses on HIV care, LGBTQ care, and primary care. We have a very diverse patient population, and [we] are very invested in our community and our community's health.

Pharmacy Times: Can you describe gender-affirming care, what it looks like, and what it consists of?

Buckoski: Sure, gender-affirming care encompasses a range of social, psychological, behavioral, and medical interventions, normally designed to support and affirm an individual's gender identity when it conflicts with the gender they were assigned at birth. There's a lot of aspects to that, including counseling, social expression, legal measures—which involve name changes and passports—hormone therapy, puberty blockers, gender-affirming surgeries. The important thing to note is these are really individualized approaches, so not every trans person is the same, and you want to make sure that each person gets individualized care based on the outcomes that they want to achieve.

Pharmacy Times: In the context of gender-affirming care, what does patient-specific care look like? How can it be catered to the individual patient?

Buckoski: In our approach here, patient-centered care—in the context of gender-affirming care—prioritizes an individual's unique needs, preferences, and experiences, and how we can cater to each person individually. We do this through active listening to know what the patient wants and how we can help them, informed decision-making between the provider and the patient, affirmation and respect, using the patient's pronouns, individualized treatment plans, and also a collaborative care team, which includes pharmacists, behavioral health [specialists], primary care [providers], all in under 1 care team and 1 roof.

Pharmacy Times: In addition to gender-affirming care, are there other holistic or supplemental aspects of care that can be provided for patients?

Buckoski: Yeah, gender-affirming care isn't just hormones or surgeries, which a lot of people think of [when they hear the term "gender-affirming care."] Really, it's a whole person approach [and] includes mental health care, emotional health care, physical health, spiritual health, social aspects of health. It's really a comprehensive health care of the entire person, not just hormones and surgeries. Also, there's a lot of other things that go along with gender-affirming care, such as voice lessons, hair removal, so it's a lot more than just hormones.

Pharmacy Times: What barriers do patients in the LGBTQ+ community face, and how can pharmacists or other health care providers create a more supportive environment for patients?

Buckoski: So stigma is very prevalent in the LGBTQ community. It's the fear of discrimination from health care providers, and this can deter a lot of LGBTQ individuals from seeking care. Also, there's a [significant] lack of cultural competency from providers, so we find a lot of providers that either don't want to provide care or say that they don't know how to provide care, or just really don't have the training. Also, there are insurance issues related around gender-affirming care, especially, and the cost of medications is a really big problem in the community.

So, anything I would say to providers or pharmacists is to stay up to date on all the latest research, and also provide a gender-affirming environment, which includes using a patient's pronouns and just being really respectful.

Pharmacy Times: How does Western NC Community Health Services provide support and care to members of the LGBTQ+ community? How do you stand out from other centers?

Buckoski: So we have here a comprehensive LGBTQ program, we treat transgender individuals, people living with HIV. We also have a full time LGBTQ health coordinator, which is a little bit different from other centers, and they help to kind of navigate the system for patients in regards to insurance, or if they need letters of support for surgeries. We also provide training by people with lived experiences—such as myself—and we also have a transgender assistance program where we provide free medications to individuals that are under 200% of the federal poverty level. So those are some unique things that we do [at Western NC Community Health] to support the community.

Pharmacy Times: Regarding clinical trials or research, what are some gaps you see and how can they be addressed? What would you like to see studied in the future?

Buckoski: So we know that there are a lot of gaps in research out there, mainly in long-term outcomes. We don't have a lot of studies on LGBTQ care, especially transgender care with regards to long-term outcomes, so that would be something that we'd really love to see.

We know that gender-affirming care is also suicide prevention, and so, that is something that also needs [to be] studied more. Social determinants of health need to be really looked at, and how housing and employment affect LGBTQ individuals, and investigating how stable housing and employment affects their health outcomes.

We also need more research into family support. We know that family support is the core to a younger person's life, so if that is interrupted in any way, how that affects the rest of their life. And also, [in general,] gaps in funding. We need the money to be able to do all of this research.

Pharmacy Times: Any final or closing thoughts?

Buckoski: Yeah, in my closing thoughts, I just want to express the importance of kindness and providing a safe and affirming environment for LGBTQ patients. That's the best thing that you can do as a provider or a pharmacist.