A trans and nonbinary patient perspective on receiving optimal health care

Rachel Dittrich (she/her) is a final-year PharmD candidate at the Roseman University of Health Sciences College of Pharmacy, and Ronald Levinson (he/him) is a final-year PharmD candidate at the University of Florida College of Pharmacy, Gainesville, and the 2022–2023 APhA–ASP Speaker of the House.

In March 2022 at the APhA Annual Meeting & Exposition in San Antonio, the APhA–ASP House of Delegates passed adopted New Business Item (NBI) 2022.1: Gender Expansive Rights, Education, and Advocacy. Within this adopted NBI, APhA–ASP encourages the improvement in care for gender-expansive patients by integrating gender-affirming therapy (GAT) into pharmacy school curriculum and supports the use of GAT in transgender and nonbinary (TNB) patients with an informed consent model.

Understanding gender dysphoria

The National Center for Transgender Equality defines transgender (or trans) people as someone whose gender identity differs from the gender they were thought to be at birth.¹

Some transgender individuals may choose to receive hormone therapy and/or gender-affirming surgery. Candidates for this hormone therapy must demonstrate a persistent gender-variant identity that meets the criteria for gender dysphoria as categorized by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).² In the DSM-5, gender dysphoria is defined as an incongruence between one’s expressed gender and their assigned gender for at least 6 months, and the definition includes having a strong desire to be treated as an alternative gender or a strong desire to be rid of one’s sex characteristics.³

Let’s use the perspectives of patients “Eri” and “Santiago” to help provide examples of this important health care issue. Eri is a trans woman who came out to her family when she was a minor. She had difficulty discussing her pronouns, let alone talking to her parents about her desire to receive gender-affirming care. Luckily, this concern was addressed by a health care provider when Eri and her parents sought GAT earlier this year.

However, it is important to note that gender dysphoria can also affect patients who identify as nonbinary, which The National Center for Transgender Equality defines as people whose gender is not male or female and who speak to an experienced gender that is not simply male or female.² Santiago unfortunately held back from medically transitioning as they thought they were seen as “less trans” or “not trans enough” to deserve GAT because they were not a binary transgender patient. They are now receiving the care they need from a health care provider who doesn’t discriminate against their health concerns.

How to make patients more comfortable

Although both Eri and Santiago are receiving GAT, both may experience microaggressions and misused pronouns in the pharmacy field, which can greatly and negatively affect patient care.

Eri mentioned how offering more gender identity options in medical paperwork can make a difference in patient care. Health care professionals can make the journey for TNB patients a more comfortable experience.⁴ For example, Kelsea Aragon, PharmD, is a pharmacist at a clinic that cares for patients with HIV and gender-expansive people. When asked how she makes her patients feel more comfortable about receiving health care, Dr. Aragon explains that it’s the health care provider’s responsibility to educate themselves in providing affirming care for everyone. Dr. Aragon also introduces herself to her patients with her pronouns, creating an environment where everyone can freely discuss gender and all health care needs.

As student pharmacists, it is our responsibility to treat all patients with respect to the best of our ability and to use each interaction as an opportunity to grow and educate ourselves.

References

1. National Center for Transgender Equality. Frequently asked questions about transgender people. Washington, DC: National Center for Transgender Equality. Available at: transequality.org/issues/resources/frequently-asked-questions-about-transgender-people. Accessed January 9, 2023.
2. Broker A-S, Loshak H. Gender Affirming Therapy for Gender Dysphoria: A Rapid Qualitative Review: Canadian Agency for Drugs and Technologies in Health: Rapid Response Report: Summary with Critical Appraisal. Canadian Agency for Drugs and Technologies in Health; 2020.
3. American Psychiatric Association. What is gender dysphoria? N.d.: American Psychiatric Association. Available at: www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria. Accessed January 9, 2023.
4. National Center for Transgender Equality. Understanding non-binary people: How to be respectful and supportive. Washington, DC: National Center for Transgender Equality; October 5, 2018. Available at: transequality.org/issues/resources/understanding-non-binary-people-how-to-be-respectful-and-supportive. Accessed January 9, 2023.