Lauren Howell, PharmD
A bill signed into law in June 2023 makes Texas the largest state so far to ban gender-affirming care for minors. Once the law takes effect in September, health care providers will be prohibited from prescribing hormones or puberty blockers. They will also be prevented from performing surgeries to help minors with gender transition. For individuals who are currently receiving prescription hormones and puberty blockers, the law requires that they be gradually taken off these medications “in a manner that is safe and medically appropriate.”
What does this mean for patients?
The bill in Texas is one of more than 75 anti-LGBTQ+ bills that have been signed into law this year alone. Kelsea Aragon, PharmD, assistant professor at The University of New Mexico College of Pharmacy, explains that “this is creating decreased access in a population that has already had difficulty accessing health care.”
While these laws vary from state to state, the barriers that they create for patients include the banning of gender-affirming care, use of appropriate restrooms, and playing sports as well as attacks on using gender-affirming pronouns, forced outing laws, and anti-drag laws. Many of these laws also add criminal consequences such as felony child abuse charges and loss of licensure for anyone found to be providing gender-affirming care.
Amy Howard, MS, PharmD, pediatric clinical pharmacist at the University of Maryland School of Pharmacy, states that “much of the legislative controversy in recent years focuses on whether gender-
affirming care of minors is harming children. Legislation being introduced is often written and promoted as a child protective action.” She also expressed that “Setting ‘timelines to detransition’ patients who are currently receiving care and restricting access to puberty suppression therapy will have a major impact on the physical and mental health of transgender youth.” A study published in PLos One by Cunningham and colleagues in December 2022 found that there is a link between suicide- and depression-related web searches and states’ passing of anti-transgender bills.
The role of pharmacists
As the most accessible health care provider, pharmacists should serve as a resource for patients affected by these laws. A 2019 article by Eckstein and colleagues published in Currents in Pharmacy Teaching and Learning reported that 40% of community pharmacists rated themselves as “not at all prepared” to counsel patients on transgender-related care. Pharmacists should be aware of local organizations and resources that will hopefully assist patients with maintaining access to care.
Advocacy, self-education, and allyship are all examples of ways that pharmacists can support patients.
“Those who work in this care space need to continue showing up to provide testimony, educating others whenever possible, and being vocal champions,” said Howard. “If we want to ensure that treatment options for transgender youth are as safe as possible, we need to promote funding well-designed research in this field. It’s also important to encourage national participation to strengthen the external validity of these studies.” Moving forward, Howard believes “the profession should solicit and amplify willing voices who can speak from their lived experiences to better inform future policy and advocacy.” ■
Building trust
As the most accessible health care provider, the easiest way for pharmacists to help is by creating a safe and welcoming environment. Specific examples from Amy Howard, MS, PharmD, of how to build trust with patients and their families include
- Start by introducing yourself, including your pronouns. By consistently normalizing use of your pronouns, you can help people feel less singled out. If you are unsure—it is always better to politely solicit their preferences than assume and risk misgendering someone.
- Mirror their language—use words from their lexicon about their body and their care to help your patients feel heard and understood.
- Avoid deadnaming (i.e., referring to someone by a name they no longer use) by saying “You introduced yourself as ______, which is different from what I have in your chart/profile. Is _______ the name you would prefer me to use?”
- Avoid assumptions about what anatomical organs a transgender patient may or may not have. If there is a medically necessary reason for you to inquire, be certain to make the reason you need to know clear to the patient.
- Adopt or advocate for systems that have gender-inclusive language and the ability to enter preferred names. ■