Expert: Pharmacists Are Well-Positioned to Provide Gender-Affirming Care

In an interview with Pharmacy Times, Alex Mills, PharmD, BCACP, AAHIVP, assistant professor of pharmacy practice at the University of Mississippi School of Pharmacy, discussed his presentation at the American Society of Health-System Pharmacists 2023 Summer Meeting. Mills’ session focuses on women’s health and gender-affirming care, and pharmacists’ roles in both.

Q: How should pharmacists approach any confusion around what they can or cannot do in their state regarding gender-affirming care and women’s health?

Alex Mills, PharmD, BCACP, AAHIVP: Yeah, I mean, I think for those in a larger health system, larger company, I think definitely roping in legal counsel to aid in how you interpret the legislation locally, on what can and cannot be done, or what's the best way to navigate that, especially if you currently have those patients or that clientele that are there, being seen where you work. And then maybe discussing along with regional and national advocacy groups. So, you know, nationally, I think of either the ACLU or HRC, which is the Human Rights Campaign, or looking for a local women's or LGBTQ-specific support organization to see, you know, what resources are available and what that landscape truly looks like in the health care setting. And then not forgetting to speak to your leadership at a system or company level to figure out what's the company or the health systems position on care for these individuals, whether it be LGBTQI+, whether it be reproductive rights, to make sure that that understanding is known, going into these conversations. We have to figure out that company's statement and culture on what really are the resources and the people to talk to.

Q: What does gender-affirming care look like in the pharmacy?

Alex Mills, PharmD, BCACP, AAHIVP: Yeah, I mean, I think I take it from the angle of it's no longer patient-centered care; it's person-centered care. There's a person that you're taking care of in front of you. So, there's a lot of ways that you can do that. I think one is looking at your environment, doing a scan of what your environment looks like. Having visual cues, whether that's, you know, particular symbols, pins, or brochures that relate to health needs for that population. Particularly when I think about LGBTQIA folks, that's a great place to start, as well as assessing what type of systems that your practice health system has for collecting. And again, going back to sexual orientation, gender identity, but how can your system collect that information? And how is it shared appropriately? So does your HER, for example, if you're working more through a clinic space, does it allow you to collect chosen names and legal names, pronouns, given the opportunity to have a patient identify both their sex assigned at birth and their gender identity in case those are different, is one great way to help affirm that that matters for your health system and that patients can see that that's important. And then also just being open to learning more on what the needs are for those patients in your pharmacy seeking gender affirming care. So, you know, many of these medications are injectables, so do you have on hand the appropriate injection supplies for a patient giving an intramuscular versus a subcutaneous injection? Having that already available if you're seeing those patients coming into your pharmacy or your clinic, maybe identifying what your local providers and prescribers are using for their resources so that you're able to then make sure that you're also up to date and to know what's going on. Because, for many of our practicing pharmacists out there who have been in practice for a while, this is new. This is a new area that we weren't taught before. I mean, I'll tell you, myself, I graduated in 2017, I was not taught gender affirming care in pharmacy school, but it didn't take much to learn it. I just had to go to the right people. So, I think all of those things played an important role in how you would provide gender affirming care.

Q: Why are pharmacists well-positioned to provide this care?

Alex Mills, PharmD, BCACP, AAHIVP: Yeah, I mean, the medications, the therapies we use in gender affirming care, they've been using them for decades. They're not new drugs. So, you know, HRT for hypogonadism, for low testosterone, using hormones for menopause, etc. You know, we as pharmacists have consistently demonstrated our expertise in medication selection, dosing, monitoring, so it's really a natural fit for pharmacists to provide this care. It's not different medications; it’s maybe a different way of approaching communication with a patient and really focusing on that. Again, that person-centered goal for their gender journey rather than just what's on an algorithm.

I think the other thing, too, that shows why we're so excellent at this is, again, the dosage form that we would choose could affect how we monitor it, the side effect profile, or how to counsel a patient on administering or injecting a drug. And again, we're trained on this. We've been trained for decades to do that. So we are certainly well positioned to provide this care.

Q: Is there anything you’d like to add?

Alex Mills, PharmD, BCACP, AAHIVP: You know, I alluded to it a little bit, but I can understand a pharmacist initially being hesitant providing gender affirming care when they haven't been taught it. Like I just mentioned, resources certainly now exist to help with that knowledge deficit and really for all of our patients that come in. I think it's important to remind those that are listening and watching or reading this that, you know, in our oath, we talked about caring for all patients using our knowledge, skills, and experience. But what isn't acceptable is allowing outside beliefs and unchallenged information to be an excuse for not facilitating this care. So, our patients deserve exceptional person-centered care, and our pharmacists are the ones to do it.