Resource spotlight: Medication for transgender patients

July 13, 2021
 

Transgender patients report that the single largest component inhibiting their access to care is a lack of provider expertise in transgender healthcare, combined with previous negative experiences and discrimination.1 A Canadian study by Heinz and MacFarlane (2013) found that 63% of trans patients who had a regular family doctor had to provide education to their doctor about trans issues.Healthcare providers in general, including pharmacists, may be hindered by the lack of education regarding transgender patients in pharmacy curriculum.3  

This week’s Resource Spotlight will highlight guidelines and useful resources to assist in your care of transgender patients. To read more about healthcare for transgender patients, check out last week's article on gender-affirming hormone therapy.


External resources *

Rainbow Health Ontario: Sherbourne Health

This guide for practitioners is based on the experience of clinicians at the Sherbourne Clinic in Toronto, Ontario.  The website provides an overview of various healthcare needs from non-medical (legal and psychosocial) to medical transitions (hormone and surgery).  Additionally, it provides detailed hormone therapy guidelines for gender-affirming hormone therapy, including quick reference guides for a feminizing hormone therapy and masculinizing hormone therapy with key messages, charts, infographics, and sample patient consent forms for hormone therapy initiation.  Full guidelines can be found here, including information on primary care issues in transgender patients.  You can also find additional resources and education and training opportunities for clinicians wishing to keep up to date.

British Columbia guidelines and resources for gender-affirming care

This provincial website offers resources to support clinicians providing gender-affirming care, including guidelines and standards (Endocrine Therapy for Transgender Adults in British Columbia:  Suggested Guidelines), helpful links for supporting patients to access surgery (funding coverage and funding request templates letters for GPs/NPs), patient information sheets discussing gender-affirming surgeries, primary care tools (a Primary Care Toolkit for Trans, Two-Spirit, and Gender Diverse Patients in BC), and articles on medical care for youth.

Northwest Territories guidelines for transgender, non-binary, and gender non-conforming patients

This document provides recently updated guidance for transgender youth and adult care, covering cultural safety, diagnosis of gender dysphoria, hormone therapy, and gender-affirming surgeries.  The guidelines also include a useful “Transgender, Non-Binary, and Gender Nonconforming Care Process Map.”

CADTH Standards of Care for Transgender Children and Adolescents

This document is a systemic review looking at four evidence-based guidelines regarding the standards of care for the health of transgender children and adolescents.

Smashing Stigma:  A pharmacist’s guide to medications for the LGBT2SQ+ population (2nd edition)

This is a useful resource from the Canadian Pharmacists Association, focusing on hormone therapy for gender transition.



References

  1. Khan J, Schmidt RL, Spittal MJ, Goldstein Z, Smock KJ, Greene DN. Venous thrombotic risk in transgender women undergoing estrogen therapy: a systematic review and metaanalysis. Clinical chemistry. 2019 Jan 1;65(1):57-66. 
  2. Heinz M, MacFarlane D. Island lives: a trans community needs assessment for Vancouver Island. SAGE Open. 2013 Sep 16;3(3):2158244013503836.
  3. Redfern, J. S., & Jann, M. W. (2019). The evolving role of pharmacists in transgender health care. Transgender health, 4(1), 118-130.https://www.liebertpub.com/doi/full/10.1089/trgh.2018.0038 


*Unless otherwise noted, the Canadian Society of Hospital Pharmacists (CSHP) does not endorse or imply endorsement of the resources provided here. These resources are provided without warranty of any kind, either expressed or implied. It is the responsibility of the user of the resource to judge its suitability for his or her particular purpose within the context of his or her practice and the applicable legislative framework. In no event shall CSHP or any persons involved in providing the resource be liable for damages arising from its use.

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