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Kaltsas A, Stavropoulos M, Symeonidis EN, Kratiras Z, Zachariou A, Zikopoulos A, Chrisofos EE, Dimitriadis F, Sofikitis N, Chrisofos M. Endometriosis in Transgender Men: Bridging Gaps in Research and Care-A Narrative Review. Biomedicines 2024; 12:1481. [PMID: 39062054 PMCID: PMC11274608 DOI: 10.3390/biomedicines12071481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Endometriosis is a debilitating gynecological condition commonly seen in individuals designated female at birth; however, there has been limited research focused on its prevalence and impact among transgender men. This narrative review aims to fill a critical knowledge gap by exploring the epidemiology, clinical manifestations, management strategies, and quality-of-life implications of endometriosis among transgender individuals who identify as male. Specifically, this study seeks to estimate the prevalence rates and describe the symptoms experienced by transgender men undergoing testosterone therapy. Additionally, it addresses the diagnostic challenges posed by hormonal treatments and the lack of culturally competent healthcare services for this population. Recent molecular studies indicate that hormonal imbalances, such as increased estrogen synthesis and progesterone resistance, are significant factors in the persistence of endometriosis symptoms despite testosterone therapy. Moreover, evidence suggests that testosterone therapy may not always suppress endometrial activity completely, contributing to the persistence of symptoms in some individuals. Endometriosis in transgender men requires personalized approaches that consider both testosterone therapy and its interactions with endometriosis, as well as fertility preservation and the psychosocial aspects of treatment. This review emphasizes the necessity of taking an inclusive approach in both research and clinical practice to improve healthcare outcomes for this underserved population. The results demonstrate how continued research, education, and healthcare services tailored specifically to transgender men are necessary to better understand and treat endometriosis, thus improving both their overall health and quality of life.
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Affiliation(s)
- Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
| | - Marios Stavropoulos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
| | - Evangelos N. Symeonidis
- Department of Urology II, European Interbalkan Medical Center, 55535 Thessaloniki, Greece; (E.N.S.); (N.S.)
| | - Zisis Kratiras
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Athanasios Zikopoulos
- Department of Obstetrics and Gynecology, Royal Cornwall Hospital, Truro TR1 3LJ, UK;
| | | | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Sofikitis
- Department of Urology II, European Interbalkan Medical Center, 55535 Thessaloniki, Greece; (E.N.S.); (N.S.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
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Stanger E, Kehr AM, McCorkindale N, Ng H. Integration of clinical pharmacists to assist with medication surveillance for patients receiving gender-affirming hormone therapy in a community ambulatory setting within the United States. J Am Pharm Assoc (2003) 2024; 64:290-294.e1. [PMID: 37839700 DOI: 10.1016/j.japh.2023.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Gender-affirming care (GAC) for gender diverse individuals (includes transgender and nonbinary persons) requires a comprehensive approach to medication surveillance, including monitoring and follow-up. Limited access to these health services can present a barrier to follow-up for routine care. Integration of a pharmacist into therapeutic management has shown positive clinical outcomes; however, their involvement with gender-affirming hormone therapy (GAHT), including routine laboratory monitoring, is not well established. OBJECTIVE This study aimed to describe the development and implementation of a protocol involving the integration of clinical pharmacists into GAC for gender diverse patients in a community ambulatory setting. PRACTICE DESCRIPTION Cleveland Clinic's Center for LGBTQ+ Care is embedded in a primary care practice and has an established protocol for GAHT management. The health system also has an established model that uses pharmacists for the management of patients, within the primary care and specialty clinic settings, under a collaborative practice agreement (CPA). PRACTICE INNOVATION The medical director of the Cleveland Clinic's Center for LGBTQ+ Care and the institution's primary care pharmacists collaborated to propose an update to the CPA to include GAHT monitoring to improve access to routine GAHT follow-up. EVALUATION METHODS GAHT management was approved to be added to the pharmacist CPA in May of 2022 and the pharmacists started seeing patients in February of 2023. The team opted to start with those patients already established on GAHT for at least 6 months, at least 1 year after transition, and with a primary care provider managing their GAHT. CONCLUSION Access to follow-up for individuals receiving GAHT may be improved through the utilization of pharmacist services. The incorporation of a CPA with pharmacists for GAHT management can allow for a multidisciplinary approach once a patient is on a stable regimen, thereby increasing provider access to new patients.
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Courtney J, Aragon KG, Douglas M, Malhotra A. A Resource Compendium for Embedding LGBTQIA+ Patient Care in the Professional Identity of Community Pharmacists. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100127. [PMID: 37852690 DOI: 10.1016/j.ajpe.2023.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/08/2023] [Accepted: 04/18/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Cultural, clinical, social, and legally competent patient care for lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) patients is currently scarcely incorporated in pharmacy curricula. Furthermore, clinical, legal, and socio-cultural training that prepares pharmacists on the job to provide LGBTQIA+ competent patient care is scant. Here, our objectives were to (1) systematically review the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify trends in community pharmacists' professional identity development related to the provision of competent LGBTQIA+ patient care, and (2) create a reference guide for community pharmacists for self-directed learning. The literature search focused on 4 professional identity domains common to most pharmacists: academic and clinical competence, cultural sensitivity, knowledge of state and federal laws, and continuing professional development. FINDINGS A total of 207 articles were identified, with 93 retrieved, of which 26 articles were included in the final analysis based on title and abstract and other inclusion criteria. SUMMARY Overall, our search identified that the LGBTQIA+ health professions literature focused on the following themes: guidance for appropriate drug selection and therapy, creation of cultural sensitivity training curricula, community pharmacists' perceptions of their ability to provide LGBTQIA+ care, health system interventions, and Allyship education for advancing LGBTQIA+ care, the need for enhanced training of pharmacists for understanding the federal and state laws and requirements while providing care, and the need for a resource compendium to help community pharmacists access self-directed learning information, for which we have created a self-help resource guide for pharmacists in these 4 professional pharmacist identity domains.
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Affiliation(s)
- Jennifer Courtney
- California Northstate University College of Pharmacy, Elk Gove, CA, USA
| | | | - Monica Douglas
- University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Ashim Malhotra
- California Northstate University College of Pharmacy, Elk Gove, CA, USA.
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Chaudhary S, Ray R, Glass BD. “I don't know much about providing pharmaceutical care to people who are transgender”: A qualitative study of experiences and attitudes of pharmacists. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100254. [PMID: 37095891 PMCID: PMC10121476 DOI: 10.1016/j.rcsop.2023.100254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Background Globally, with the increased visibility, the number of transgender people accessing healthcare services has risen in the last decade. Although pharmacists are required to provide equitable and respectful care to all patients, their experiences interacting with trans and gender-diverse (TGD) people and attitudes towards the provision of care are largely unknown. Objectives This study aimed to determine the experiences and attitudes of pharmacists providing care to TGD people in Queensland, Australia. Methods Within a transformative paradigm, this study used semi-structured interviews conducted in person, over the phone, or through the Zoom app. Data were transcribed and analyzed by applying the constructs of the Theoretical Framework of Accessibility (TFA). Results A total of 20 participants were interviewed. Analysis revealed all seven constructs across interview data, with affective attitude and self-efficacy being the most frequently coded constructs, followed by burden and perceived effectiveness. The least coded constructs included ethicality, intervention coherence, and opportunity cost. Pharmacists had positive attitudes towards providing care and interacting professionally with TGD people. Prime challenges in delivering care were being unaware of inclusive language and terminology, difficulty building trusted relationships, privacy and confidentiality at the pharmacy, inability to locate appropriate resources, and lack of training in TGD health. Pharmacists felt rewarded when they established rapport and created safe spaces. However, they requested communication training and education to improve their confidence in delivering care to TGD people. Conclusion Pharmacists demonstrated a clear need for further education on gender-affirming therapies and training in communication with TGD people. Including TGD care in pharmacy curricula and continuous professional development activities is seen as an essential step towards pharmacists improving health outcomes for TGD people.
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Chaudhary S, Ray R, Glass BD. “Treat us as a person”: A narrative inquiry of experiences and expectations of interactions with pharmacists and pharmacy staff among people who are transgender. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 8:100198. [PMCID: PMC9634356 DOI: 10.1016/j.rcsop.2022.100198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
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Gusmão-Silva JV, Lichtenecker DCK, Ferreira LGA, Gois Í, Argeri R, Gomes GN, Dias-da-Silva MR. Body, metabolic and renal changes following cross-sex estrogen/progestogen therapy in a rodent model simulating its use by transwomen. J Endocrinol Invest 2022; 45:1875-1885. [PMID: 35689728 DOI: 10.1007/s40618-022-01817-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The use of sex steroids by trans people has been of paramount importance regarding body changes during gender transition. The objective of this study was to assess the effects of an injectable steroid combination frequently used by transwomen, namely estradiol enanthate with dihydroxyprogesterone acetophenide (E2EN/DHPA), on blood pressure and metabolic outcomes using an animal model. METHODS Two-month-old male Wistar rats were orchiectomized or sham-operated and divided into groups: (1) Sham treated with sesame oil vehicle (SG), (2) sham treated with E2EN/DHPA (SP), (3) orchiectomized rats treated with vehicle (OG), and (4) orchiectomized rats treated with E2EN/DHPA (OP), with all groups treated every 10 days for 5 months. We evaluated systolic blood pressure (SBP), body weight (BW), abdominal circumference, nasoanal length (NAL), food and water intake (FI, WI), lipid profile (triglycerides, LDL, and HDL), serum C-reactive protein (CRP), plasma concentrations of urea (URpl) and creatinine (CRpl), 24 h urinary volume (V24 h), sodium and potassium excretion (UNa+, UK+), and proteinuria. RESULTS E2EN/DHPA administration reduced BW (SP 324.5 ± 31.1; OP 291.7 ± 41.3 g) and NAL (SP 24.5 ± 0.4; OP 24.6 ± 1.0 cm), without changing blood pressure, but increased URpl concentration (SP 55.0 ± 4.8; OP 42.5 ± 8.8 mg/dL) and CRpl (SP 0.47 ± 0.05; OP 0.46 ± 0.04 mg/dL), sodium (SP 3.1 ± 0.8; OP 3.3 ± 0.4 µEq/min/kg), potassium (SP 0.91 ± 0.22; OP 0.94 ± 0.22 µEq/min/kg) excretions and urinary volume (SP 15.5 ± 2.1; OP 16.4 ± 2.9 mL/24 h). CONCLUSION Cross-sex hormone therapy with E2EN/DHPA significantly modified body characteristics in male rats, producing a feminizing change without altering blood pressure or generating harmful metabolic parameters, but larger translational studies are still needed.
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Affiliation(s)
- J V Gusmão-Silva
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil
| | - D C K Lichtenecker
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil
| | - L G A Ferreira
- Laboratory of Molecular and Translational Endocrinology (LEMT), Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Pedro de Toledo, nº 699, Sao Paulo, 04039-032, Brazil
| | - Í Gois
- Laboratory of Molecular and Translational Endocrinology (LEMT), Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Pedro de Toledo, nº 699, Sao Paulo, 04039-032, Brazil
- Trans Care Outpatient Clinics; Núcleo de Estudos, Pesquisa, Extensão e Assitência à Pessoa Trans Professor Roberto Farina, Universidade Federal de Sao Paulo (Núcleo TransUnifesp), Rua Napoleão de Barros nº 859, Sao Paulo, 04024-002, Brazil
| | - R Argeri
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil
| | - G N Gomes
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil.
| | - M R Dias-da-Silva
- Laboratory of Molecular and Translational Endocrinology (LEMT), Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Pedro de Toledo, nº 699, Sao Paulo, 04039-032, Brazil
- Trans Care Outpatient Clinics; Núcleo de Estudos, Pesquisa, Extensão e Assitência à Pessoa Trans Professor Roberto Farina, Universidade Federal de Sao Paulo (Núcleo TransUnifesp), Rua Napoleão de Barros nº 859, Sao Paulo, 04024-002, Brazil
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Melton TC, Johnson WT, Tipton B, Aragon KG, Daniels CC, Renfro CP. Improving Pharmacy Students' Clinical Knowledge on Providing Care for Patients Belonging to the LGBTQ+ Community. PHARMACY 2022; 10:pharmacy10040070. [PMID: 35893708 PMCID: PMC9326589 DOI: 10.3390/pharmacy10040070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 02/01/2023] Open
Abstract
A 12-question survey instrument was developed, pilot-tested, and administered to 191 pharmacy students in their first professional year after engaging in a learning activity focusing on topics across five categories with clinical relevance to providing care to the LGBTQ+ community. A paired student t-test was performed on survey tool pre-test and post-test survey responses, with p < 0.05 considered significant. A total of 183 usable pre-test and post-test survey responses were received. Statistically significant differences between the pre-test and post-test correct responses were observed for scenarios involving proper pronoun use, hormone therapy (HT) counseling, immunization best practices, and communication hesitancy. The greatest knowledge change was reported in the categories of immunization best practices (48.9%), HT counseling (33.6%), and pronoun use (22.8%). Active learning assignments are effective teaching strategies to promote clinical knowledge in providing inclusive and culturally competent care to LGBTQ+ patients. Clinical topic areas including proper pronoun use, HT counseling, immunization best practices, privacy, risk awareness, and communication hesitancy are effective curricula additions for pharmacy colleges to advance inclusive curricula concerning providing care to the LGBTQ+ community.
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Affiliation(s)
- Tyler C. Melton
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN 38103, USA; (W.T.J.III); (B.T.); (C.P.R.)
- Correspondence:
| | - William T. Johnson
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN 38103, USA; (W.T.J.III); (B.T.); (C.P.R.)
| | - Brittany Tipton
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN 38103, USA; (W.T.J.III); (B.T.); (C.P.R.)
| | - Kelsea G. Aragon
- College of Pharmacy, University of New Mexico, Albuquerque, NM 87106, USA;
| | | | - Chelsea Phillips Renfro
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN 38103, USA; (W.T.J.III); (B.T.); (C.P.R.)
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Abrams LM, Look K, Imhoff L. The importance of providing gender-affirming care in pharmacy practice. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100135. [PMID: 35909713 PMCID: PMC9335925 DOI: 10.1016/j.rcsop.2022.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/05/2022] Open
Abstract
Transgender and gender diverse (TGD) individuals face bias and discrimination across many health care settings including pharmacy. While there is evidence of successful interventions to increase provider awareness of the needs of TGD individuals in medicine, nursing, and social work, little work has been done by the pharmacy profession to recognize and meet the needs of this population. This commentary examines the gaps in pharmacy practice and pharmacy research with regards to the needs of TGD individuals and looks at allied health fields for potential solutions that can be adapted by the pharmacy profession. We first examine the social pressures that TGD individuals face in multiple social contexts and describe how bias and discrimination spill over into their interactions with providers and health care systems. Solutions for improving pharmacy practice research's ability to identify TGD individuals and their needs follows as a measure that will lead to solutions for improving pharmacy practice. A discussion of TGD individuals' responses to actual and perceived discrimination by pharmacists is discussed next, and why their avoidance of pharmacy care can be problematic to their health. The remainder of the paper focuses on how pharmacy education can train future pharmacists to provide inclusive care to TGD individuals, and how interprofessional education and continuing education can enhance future and practicing pharmacists' ability to provide high quality care to TGD individuals.
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Affiliation(s)
| | - Kevin Look
- University of Wisconsin-Madison, United States of America
| | - Lisa Imhoff
- University of Wisconsin-Madison, United States of America
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Pinho AADS, Silva Filho CCD, Silva DTD, Nunes DM, Silva SPCE, Pio ID. The pharmacist’s role on transgender care: findings from a literature review. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e18426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lau F, Antonio M, Davison K, Queen R, Devor A. A rapid review of gender, sex, and sexual orientation documentation in electronic health records. J Am Med Inform Assoc 2021; 27:1774-1783. [PMID: 32935124 PMCID: PMC7671624 DOI: 10.1093/jamia/ocaa158] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/19/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022] Open
Abstract
Objective The lack of precise and inclusive gender, sex, and sexual orientation (GSSO) data in electronic health records (EHRs) is perpetuating inequities of sexual and gender minorities (SGM). We conducted a rapid review on how GSSO documentation in EHRs should be modernized to improve the health of SGM. Materials and Methods We searched MEDLINE from 2015 to 2020 with terms for gender, sex, sexual orientation, and electronic health/medical records. Only literature reviews, primary studies, and commentaries from peer-reviewed journals in English were included. Two researchers screened citations and reviewed articles with help from a third to reach consensus. Covidence, Excel, and Atlas-TI were used to track articles, extract data, and synthesize findings, respectively. Results Thirty-five articles were included. The 5 themes to modernize GSSO documentation in EHRs were (1) creating an inclusive, culturally competent environment with precise terminology and standardized data collection; (2) refining guidelines for identifying and matching SGM patients with their care needs; (3) improving patient-provider relationships by addressing patient rights and provider competencies; (4) recognizing techno-socio-organizational aspects when implementing GSSO in EHRs; and (5) addressing invisibility of SGM by expanding GSSO research. Conclusions The literature on GSSO documentation in EHRs is expanding. While this trend is encouraging, there are still knowledge gaps and practical challenges to enabling meaningful changes, such as organizational commitments to ensure affirming environments, and coordinated efforts to address technical, organizational, and social aspects of modernizing GSSO documentation. The adoption of an inclusive EHR to meet SGM needs is a journey that will evolve over time.
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Affiliation(s)
- Francis Lau
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Marcy Antonio
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Kelly Davison
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Roz Queen
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Aaron Devor
- Department of Sociology, University of Victoria, Victoria, Canada
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Ramsey DC, Lawson MM, Stuart A, Sodders E, Working ZM. Orthopaedic Care of the Transgender Patient. J Bone Joint Surg Am 2021; 103:274-281. [PMID: 33252585 DOI: 10.2106/jbjs.20.00628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
» A transgender person is defined as one whose gender identity is incongruent with their biological sex assigned at birth. This highly marginalized population numbers over 1.4 million individuals in the U.S.; this prevalence skews more heavily toward younger generations and is expected to increase considerably in the future. » Gender-affirming hormone therapy (GAHT) has physiologic effects on numerous aspects of the patient's health that are pertinent to the orthopaedic surgeon, including bone health, fracture risk, and perioperative risks such as venous thromboembolism and infection. » Language and accurate pronoun usage toward transgender patients can have a profound effect on a patient's experience and on both objective and subjective outcomes. » Gaps in research concerning orthopaedic care of the transgender patient are substantial. Specific areas for further study include the effects of GAHT on fracture risk and healing, outcome disparities and care access across multiple subspecialties, and establishment of perioperative management guidelines.
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Affiliation(s)
- Duncan C Ramsey
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Michelle M Lawson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Ariana Stuart
- Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Emelia Sodders
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Zachary M Working
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Chaudhary S, Ray R, Glass B. Pharmacists' role in transgender healthcare: A scoping review. Res Social Adm Pharm 2021; 17:1553-1561. [PMID: 33436315 DOI: 10.1016/j.sapharm.2020.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/19/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Transgender patients have unique healthcare needs, providing pharmacists with the opportunity to play an important role in transgender care through addressing the healthcare disparities observed in this patient group. OBJECTIVE This scoping review aimed to explore the role of pharmacists in transgender healthcare. METHODS Six databases were searched from inception: Emcare, Informit, MEDLINE (Ovid), PubMed, Scopus, and Web of Science. The first author performed screening and data extraction in consensus with co-authors. Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was utilised to report this review. Themes related to the role of pharmacists in transgender healthcare were identified. RESULTS A total of 356 studies were identified; however, only 15 studies, all from the USA met the selection criteria and were included in this review. Study types included empirical research, practice reports and opinion pieces such as commentaries, editorials, and reports. Pharmacists were found to practise in two different care settings: community and interdisciplinary clinics, performing various roles in transgender healthcare, including patient education and counselling, management of cross-sex hormonal therapy, patient advocacy and provision of preventative care. They were also responsible for the provision of culturally sensitive care in an inclusive and welcoming environment. Although pharmacists considered their role important, they lacked confidence in their knowledge to provide appropriate care to this patient group. CONCLUSION This review has highlighted that there is a need for education in transgender care for both pharmacists and pharmacy students, so that they are both confident and comfortable to play a meaningful role in transgender care. Pharmacists' involvement in addressing the health disparities experienced will contribute to improving the overall health outcomes for this group.
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Affiliation(s)
- Swapna Chaudhary
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, QLD, 4811, Australia.
| | - Robin Ray
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, QLD, 4811, Australia
| | - Beverley Glass
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, QLD, 4811, Australia
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Rosa-Vega J, Carlo E, Rodríguez-Ochoa A, Hernández-Agosto J, Santiago Quiñones D, Cabrera-Candelaria D, Rodríguez-Díaz CE, Melin K. Educational intervention to improve pharmacist knowledge to provide care for transgender patients. Pharm Pract (Granada) 2020; 18:2061. [PMID: 33343770 PMCID: PMC7739511 DOI: 10.18549/pharmpract.2020.4.2061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Most pharmacists have not received formal training or education in the
provision of care for transgender patients. Nonetheless, pharmacists have
the potential to be valuable partners in the care of transgender patients,
and a continuing education course might be valuable in addressing this
knowledge gap. Objective: The aim of this study was to examine the impact of a three-hour continuing
education course in improving the knowledge of pharmacists to provide
pharmaceutical care for transgender patients. Methods: A quasi-experimental, one-group pre-test/post-test study design was used to
measure the impact of a three-hour continuing pharmacy education course on
the knowledge of pharmacists on transgender care. The course was divided
into three units: (1) Transgender Patient Care Introduction, (2) General
Health Issues of Transgender Patients, and (3) Gender Affirming Hormone
Therapy. A total of 68 pharmacists participated in the study, of which 54
completed both the pre- and post-test. An ANOVA was used to compare
differences in knowledge in the group before and after the educational
intervention. Results: The majority of the participating pharmacists were cisgender, heterosexual
women who had not received any formal training related to transgender care.
Participants demonstrated the largest increase in execution score in the
third unit, with a percent improvement of 25.22% (pre-test
45.06%, post-test 70.28%; p<0.001). The average total
execution score was 52.15% in the pre-test and 72.89%
(p< 0.001) in the post-test. Conclusions: Pharmacists benefited from a three-hour continuing education course with an
increase in knowledge regarding transgender patient care and hormone therapy
for gender affirmation. As this study only evaluated the effect in short
term memory, further studies are needed to assess long term impact of the
continuing education course on transgender care knowledge.
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Affiliation(s)
| | - Edgar Carlo
- PharmD. School of Pharmacy, University of Puerto Rico. San Juan, (Puerto Rico).
| | | | - Jonathan Hernández-Agosto
- EdD. Associate Professor, Director of Curriculum and Institutional Effectiveness. School of Pharmacy, University of Puerto Rico. San Juan, (Puerto Rico).
| | - Darlene Santiago Quiñones
- PhD, MS. Associate Professor. School of Pharmacy, University of Puerto Rico. San Juan, (Puerto Rico).
| | | | - Carlos E Rodríguez-Díaz
- PhD, MPHE, MCHES. Associate Professor, Director Community-Oriented Primary Care Program. Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University. Washington, DC (United States).
| | - Kyle Melin
- PharmD, MSc, BCPS. Associate Professor. School of Pharmacy, University of Puerto Rico. San Juan, (Puerto Rico).
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14
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Cirrincione LR, Senneker T, Scarsi K, Tseng A. Drug Interactions with Gender-Affirming Hormone Therapy: Focus on Antiretrovirals and Direct Acting Antivirals. Expert Opin Drug Metab Toxicol 2020; 16:565-582. [PMID: 32479127 DOI: 10.1080/17425255.2020.1777278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Gender-affirming care may include hormonal therapy to attain desired health outcomes in transgender (trans) individuals. To provide safe, affirming medical care for trans patients, health care providers must identify and manage drug-drug interactions (DDIs) between gender affirming hormonal therapy (GAHT) and other medication therapies. AREAS COVERED This review summarizes available data on DDIs between GAHT and antiretrovirals (ARVs) or hepatitis C direct acting antivirals (DAAs). Potential pharmacokinetic and pharmacodynamic DDIs are predicted based on GAHT, ARV, and DAA pharmacology and adverse event profiles. Clinical management strategies are discussed. EXPERT OPINION GAHT may be involved in pharmacokinetic and/or pharmacodynamic DDIs. Certain ARV classes (non-nucleoside reverse transcriptase inhibitors, protease inhibitors) may alter GAHT disposition, whereas selected ARVs (unboosted integrase inhibitors, doravirine, or rilpivirine) may have less impact on GAHT. DAAs may interact with GAHT, but the clinical relevance is unclear. ARV- and/or DAA-associated side effects (including depression, cardiovascular disease, hyperlipidemia) are important to consider in the clinical management of trans patients. Clinicians must evaluate potential DDIs and overlapping side effects between ARVs, DAAs and GAHT when providing care for trans patients.
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Affiliation(s)
- Lauren R Cirrincione
- Department of Pharmacy, University of Washington School of Pharmacy , Seattle, WA, USA
| | - Tessa Senneker
- Department of Pharmacy, Kingston General Hospital , Kingston, ON, Canada
| | - Kimberly Scarsi
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center , Omaha, NE, USA
| | - Alice Tseng
- Faculty of Pharmacy, University of Toronto , Toronto, ON, Canada.,University Health Network , Toronto, ON, Canada
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15
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Knockel LE, Ray ME, Miller ML. Incorporating LGBTQ health into the curriculum: Assessment of student pharmacists' knowledge and comfort level in caring for transgender patients. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:928-935. [PMID: 31570131 DOI: 10.1016/j.cptl.2019.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND PURPOSE This study aimed to measure the effects of instruction regarding transgender health in second-year student pharmacists and provide qualitative insight regarding their impressions of the educational experience. EDUCATIONAL ACTIVITY AND SETTING Students completed a pre- and post-survey assessing knowledge regarding transgender therapeutics, the pharmacist's role, level of comfort providing care, and impression of exposure to the topic. McNemar's test and paired t-tests compared respondent data before and after the activity. The post-survey evaluated the learning activity, with an opportunity to leave open comments that were then analyzed using content analysis. FINDINGS Eighty-five of 107 (79.4%) students completed both surveys and were included in the analysis. Transgender therapeutics knowledge, participant understanding of pharmacist's role, comfort level, and assessment of adequateness of exposure improved significantly (p < 0.001). A majority (82.4%) affirmed that more than one exposure to issues regarding care of transgender patients is needed in the curriculum. Fifty-five open comments offered by 23 students were coded and categorized into two overall themes with four and two subthemes, respectively. Strengths of the activity were topic importance, exposure appreciation, presentation style, and knowledge foundation. Opportunities for improvement included providing more information and different types of information. SUMMARY The activity increased student pharmacists' knowledge regarding transgender therapeutics, the pharmacist's role, and comfort level in caring for this patient population. Respondents found the content valuable and desired more. Colleges of pharmacy should consider increasing exposure to specific patient populations, such as transgender patients, to prepare students for practice.
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Affiliation(s)
- Laura E Knockel
- University of Iowa College of Pharmacy, 115 S Grand Avenue, Room 222, Iowa City, IA 52242, United States.
| | - Mary Elizabeth Ray
- University of Iowa College of Pharmacy, 115 S Grand Avenue, Room 318, Iowa City, IA 52242, United States.
| | - Michelle L Miller
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States.
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16
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Abstract
An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs. It is essential that anesthesia providers develop the knowledge and skills necessary for safely managing transgender patients in the perioperative setting. This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient.
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17
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Melin K, Hilera-Botet CR, Vega-Vélez D, Salgado-Crespo VM, Santiago D, Hernández-Agosto J, Muñoz-Burgos A, Cajigas Z, Martínez-Vélez JJ, Rodríguez-Díaz CE. Readiness to provide pharmaceutical care to transgender patients: Perspectives from pharmacists and transgender individuals. J Am Pharm Assoc (2003) 2019; 59:651-659. [PMID: 31153824 DOI: 10.1016/j.japh.2019.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objectives of this study were (1) to assess pharmacist readiness to provide pharmaceutical care for transgender patients through measuring both pharmacists' knowledge and attitudes towards transgender patients, (2) to assess transgender patients' perception of pharmacist readiness to provide them pharmaceutical care through measuring both pharmacists' knowledge and attitudes toward them, and (3) to compare pharmacist readiness to provide pharmaceutical care for transgender patients and patient perception of this readiness. DESIGN The study used a descriptive, cross-sectional design. The pharmacist's readiness and the transgender patient's perception of their readiness, defined as a combination of knowledge and attitude, were evaluated. Two separate, validated questionnaires with dichotomous, multiple choice, and open-ended questions were used to measure both constructs among both populations. SETTING Community-based research. PARTICIPANTS Pharmacists practicing in Puerto Rico were provided the questionnaire by e-mail or in person. Transgender participants in Puerto Rico were recruited through health clinics and community partners and were surveyed in person. The analysis included responses from 96 pharmacists and 31 transgender participants. RESULTS The majority of the pharmacists' knowledge scores (90%) were found in the low (0-5) and moderate (6-10) ranges, with a mean score of 7.23 out of a total possible score of 16 (SD ±2.36). For the attitude construct, most of the scores (81%) were found in the high (18-26) range, with a mean score of 19.63 out of a total possible score of 26 (SD ±3.65). For both constructs, transgender patient perceptions echoed the results of the pharmacists, indicating several perceived knowledge deficits in combination with mostly positive attitudes. CONCLUSION The majority of pharmacists demonstrated positive attitudes toward caring for transgender patients, and transgender patients also perceived these positive attitudes from pharmacists. However, the measured and perceived knowledge deficits observed in this study suggest the need for educational interventions to improve pharmacist readiness to provide care for transgender patients.
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18
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Abstract
Pharmacists are increasingly part of a multifaceted team providing health care to members of the often marginalized transgender (TG) community. Some pharmacists, however, may feel unprepared to care for and interact with TG individuals. By providing comprehensive, respectful, and gender-affirming support, improving physical pharmacy environments with policies and procedures, pharmacists can be trustworthy providers for TG patients. This review focuses primarily on the health issues of TG persons and the pharmacist's role in promoting health, identifying barriers to health care, and providing health care resources for TG persons. The evolution of psychiatric diagnostic criteria, access to health care, and inclusion of TG, lesbian, gay, and bisexual topics in the educational curriculum are presented. Cultural competency and diversity training that addresses gender identity and sexual orientation issues should be important interdisciplinary and interprofessional activities for all health care professional education programs. Pharmacists play a key role in the health care needs of TG persons that include appropriate laboratory monitoring, complex pharmacotherapeutic challenges, and providing unbiased gender-affirming interactions. The pharmacy's physical environment, staff training, and policies and procedures can offer unique services to TG persons.
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Affiliation(s)
- Jan S Redfern
- Department of Pharmacotherapy, University of North Texas System College of Pharmacy, Fort Worth, Texas.,Redfern Strategic Medical Communications, Inc., Springtown, Texas
| | - Michael W Jann
- Department of Pharmacotherapy, University of North Texas System College of Pharmacy, Fort Worth, Texas
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19
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Lewis NJW, Batra P, Misiolek BA, Rockafellow S, Tupper C. Transgender/gender nonconforming adults’ worries and coping actions related to discrimination: Relevance to pharmacist care. Am J Health Syst Pharm 2019; 76:512-520. [DOI: 10.1093/ajhp/zxz023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nancy J W Lewis
- Department of Pharmacy Practice,University of Michigan College of Pharmacy, Ann Arbor, MI
- Transcend the Binary, Ferndale, MI
| | - Peter Batra
- Institute of Social Research, University of Michigan, Ann Arbor, MI
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20
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Ferreira ACG, Coelho LE, Jalil EM, Luz PM, Friedman RK, Guimarães MRC, Moreira RC, Eksterman LF, Cardoso SW, Castro CV, Derrico M, Moreira RI, Fernandes B, Monteiro L, Kamel L, Pacheco AG, Veloso VG, Grinsztejn B. Transcendendo: A Cohort Study of HIV-Infected and Uninfected Transgender Women in Rio de Janeiro, Brazil. Transgend Health 2019; 4:107-117. [PMID: 30972370 PMCID: PMC6455979 DOI: 10.1089/trgh.2018.0063] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Worldwide, the burden of adverse health conditions is substantial among travestis and transgender women (trans women). Transcendendo, the first trans-specific cohort in a low- or middle-income country, is an open cohort established in August 2015 to longitudinally evaluate the health aspects of trans women aged ≥18 years in Rio de Janeiro, Brazil. Methods: Study visits occur on an annual basis. Data on sociodemographics, behavioral, gender transition, affirmation procedures, hormone use, discrimination, violence, clinical and mental health, HIV prevention, and care (for those HIV-infected) are collected. Physical examination, anthropometric measurements, and laboratory tests are performed. Results: As of July 2017, 322 trans women were enrolled in the cohort with a median age of 31.5 years (interquartile range 25.7–39.5), of whom 174 (54%) were HIV-infected. The Transcendendo baseline information reinforces the scenario of marginalization and deprivation surrounding trans women. Most participants had low income (62.0% were living with below US$ 10.00/day), showed a very high engagement in sex work (78.6%), and reported increased occurrence of sexual (46.3%) and physical (54.0%) violence. Pre-exposure peophylaxis (PReP) was used by 18.8% of the HIV-uninfected trans women, only through research participation. Positive screening for depression (57.8%) and problematic use of tobacco (56.6%), cannabis (28.9%), cocaine (23.8%), and alcohol (21.5%) were high. Almost all participants (94.8%) reported hormone use at some point, mostly without medical supervision (78.7%). Conclusion: Our results describe a context of exclusion experienced by trans women, exposing vulnerabilities of this population in a middle-income country, with poor access to trans-specific care, HIV prevention and care, and mental health care. Addressing transgender experiences and needs can help the development of strategies to diminish stigma, improve health care environment, guide future research on trans morbidities, substance use, and trans-specific interventions to support health-related recommendations. Ultimately, it contributes to close the gaps concerning transgender health and reinforces that trans care cannot be disentangled from the social environment that surrounds trans women.
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Affiliation(s)
| | - Lara Esteves Coelho
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Emilia Moreira Jalil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ruth K Friedman
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria Regina C Guimarães
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rodrigo C Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Leonardo F Eksterman
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cristiane V Castro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Monica Derrico
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Biancka Fernandes
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Luciana Kamel
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Antonio G Pacheco
- Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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21
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Abstract
Gender dysphoria is defined as a marked incongruence between one's natal gender and gender identity that causes significant distress. It may be present in children but often fades prior to puberty. Gender dysphoria is more likely to persist into adulthood when present in adolescents. Due to the common occurrence of psychiatric comorbidities, gender dysphoria is a contributing factor leading to outpatient and inpatient psychiatric care in children and adolescents. There is currently limited available literature on psychiatric hospitalization and management in transgender adolescents. A PubMed search revealed no case reports regarding psychiatric admission for transgender adolescents with comorbid anxiety, depression, or suicidal ideation. Due to the lack of literature related to psychiatric management of transgender adolescent patients, this case series briefly describes the past medical history, pharmacotherapy, and discharge diagnoses of 5 transgender adolescents admitted to an inpatient psychiatry unit. In this case series, 4 of the 5 patients identified as female to male and ages ranged from 13 to 17 years. All patients had a history of depressive symptoms with suicidal ideation as the key factor prompting admission. All patients were managed on psychotropic pharmacotherapy, and 3 of the 5 patients were on pharmacotherapy related to gender transition. Anxiety, depression, and suicidal ideation were common comorbidities leading to psychiatric hospitalization of adolescent transgender patients in various stages of gender transitioning in this case series.
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Affiliation(s)
- Jennifer N Alastanos
- Clinical Pharmacist - Psychiatry, Morton Plant North Bay Hospital, BayCare Health System, New Port Richey, Florida, . Previously: Virginia Commonwealth University Health System, Richmond, Virginia
| | - Sandra Mullen
- Clinical Pharmacist - Psychiatry and Clinical Assistant Professor - Pharmacy and Psychiatry, Virginia Commonwealth University Health System, Virginia Treatment Center for Children, Richmond, Virginia
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22
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Ostroff JL, Ostroff ML, Billings S, Nemec EC. Integration of transgender care into a pharmacy therapeutics curriculum. CURRENTS IN PHARMACY TEACHING & LEARNING 2018; 10:463-468. [PMID: 29793708 DOI: 10.1016/j.cptl.2017.12.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/06/2017] [Accepted: 12/24/2017] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND PURPOSE To examine the impact of a lecture on transgender health given during a special populations therapeutics course on third-year (P3) pharmacy students' knowledge and confidence of transgender care. EDUCATIONAL ACTIVITY AND SETTING A two-hour lecture that included both cultural sensitivity and pharmacotherapy aspects of care for transgender individuals was added to a required two-credit therapeutics series offered at the end of the P3 year of a doctor of pharmacy curriculum. Following the lecture, students completed a 17-item knowledge-based survey and ranked their confidence with each answer on a 5-point scale. Students in the fourth-year (P4) class, who had not been given the lecture, also completed the survey. FINDINGS Students who attended the lecture had a significantly higher mean knowledge score and mean confidence score than students who did not attend. The P3 class had a mean knowledge score of 72.5% while the mean knowledge score for the P4 class was 63.4% (P < 0.01). The P3's mean confidence score was 76.8% and the P4's mean confidence score was 60.6% (P < 0.01). DISCUSSION To the authors' knowledge, this is the first report on incorporating the topic of transgender care to a required disease and therapeutics series in a college of pharmacy curriculum. SUMMARY Students who attended a lecture on care of transgender individuals performed significantly better on a knowledge-based assessment and reported having greater confidence in their answers than students who did not attend the lecture.
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Affiliation(s)
- Jared L Ostroff
- Department of Pharmacy Practice, Western New England University College of Pharmacy, 1215 Wilbraham Road, Springfield, MA 01119, United States.
| | - Marissa L Ostroff
- Western New England University College of Pharmacy, Springfield, MA, United States
| | | | - Eric C Nemec
- Sacred Heart University, Fairfield, CT, United States
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23
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Untersmayr E, Jensen AN, Walch K. Sex hormone allergy: clinical aspects, causes and therapeutic strategies - Update and secondary publication. World Allergy Organ J 2017; 10:45. [PMID: 29308112 PMCID: PMC5745953 DOI: 10.1186/s40413-017-0176-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/06/2017] [Indexed: 12/05/2022] Open
Abstract
Sex hormone allergy as a clinical syndrome has been known for almost a century. Due to the diversity of clinical presentation regarding symptoms and disease patterns, the optimal patient care represents an enormous interdisciplinary challenge. Frequently, hypersensitivity reactions affect more than one sex hormone and double positive tests for estrogen and progesterone have been described. Since the menstrual cycle dependent symptoms range from skin afflictions, gynecological problems to non-specific reactions, different pathophysiological mechanisms seem likely. Various desensitization protocols are described as causal treatment options, but are rarely applied in clinical routine. Consequently, major research efforts with a quick translation of therapeutic interventions into clinical practice will be crucial to help affected patients in the future.
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Affiliation(s)
- E Untersmayr
- Institute for Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - A N Jensen
- AllergyCare - Allergy Diagnosis and Study Center Vienna, Vienna, Austria
| | - K Walch
- Department of Gynecological Endocrinology and Reproductive Medicine, Clinic of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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24
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Owens RE, Wargo KA. Transgender students in pharmacy school part 2: How faculty advisors can support their advisees. CURRENTS IN PHARMACY TEACHING & LEARNING 2017; 9:957-961. [PMID: 29233391 DOI: 10.1016/j.cptl.2017.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/07/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
Faculty advisors serve a critical role in the success of pharmacy students during their academic careers, frequently serving as a problem-solver or sounding board during times of both triumph and struggle. Additionally, faculty advisors help students overcome barriers along their journey to ensure a successful progression through pharmacy school. This role is particularly important to transgender students, given the additional barriers they may face, which were highlighted in Part One of the commentary on transgender students in pharmacy school. To help faculty serve as a successful mentor to transgender advisees, Part Two of the commentary provides resources and insights into advising transgender students, including those actively undergoing gender transition.
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Affiliation(s)
- Ryan E Owens
- Wingate University School of Pharmacy, Hendersonville Health Sciences Center, 805 Sixth Ave. West, Hendersonville, NC 28739, United States.
| | - Kurt A Wargo
- Wingate University School of Pharmacy, Hendersonville Health Sciences Center, 805 Sixth Ave. West, Hendersonville, NC 28739, United States.
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25
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Wargo KA, Owens RE. Transgender students in pharmacy school, part 1: What academic administrators need to know. CURRENTS IN PHARMACY TEACHING & LEARNING 2017; 9:951-956. [PMID: 29233390 DOI: 10.1016/j.cptl.2017.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/09/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
While gender transition is a very exciting time for most students embarking upon this personal journey, it is not without its stressors as well. For students choosing to further their education and become pharmacists, the complexity and demands of pharmacy education during the transition period can be one such additive stressor. As pharmacy educators and administrators, we have the ability to help shape this professional journey and alleviate stress by maintaining our obligation to provide a safe and non-discriminatory learning environment for all students. Therefore, this two-part commentary will serve as a means to provide information and insights to administrators and faculty advisors in order to ensure transgender students, including those actively undergoing gender transition, achieve both a successful transition and pharmacy school career.
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Affiliation(s)
- Kurt A Wargo
- Wingate University School of Pharmacy, Hendersonville Health Sciences Center, 805 Sixth Ave. West, Hendersonville, NC 28739, United States.
| | - Ryan E Owens
- Wingate University School of Pharmacy, Hendersonville Health Sciences Center, 805 Sixth Ave. West, Hendersonville, NC 28739, United States.
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26
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Maxwell E, Salch S, Boliko M, Anakwe-Charles G. Discrepancies in Lesbian, Gay, Bisexual, and Transgender Patient Care and How Pharmacists Can Support an Evolved Practice. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2017; 81:6181. [PMID: 29109564 PMCID: PMC5663655 DOI: 10.5688/ajpe8176181] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 06/14/2017] [Indexed: 05/27/2023]
Abstract
We live in an increasingly multicultural society with people from different ethnicities and beliefs. In recent years, we have witnessed a growing group of people who identify as having diverse sexual orientations and gender identities. Members of the lesbian, gay, bisexual, and transgender (LGBT) community have historically been marginalized by the health care industry. The disproportionate prevalence of LGBT health concerns and cultural prejudices may be overlooked by many practitioners. As pharmacists, we are in an optimal position to affect meaningful changes in how we treat, counsel, and interact with all our patients, including with those whose sexual orientation or gender identity differ from ours. It is important for student and practicing pharmacists alike to receive adequate education and training that identifies the role of a pharmacist in LGBT health and fosters culturally competent and equitable patient care. Clinical and cultural competence should be reflective of inclusive pharmacy programs that embrace and incorporate LGBT health. The objectives of this commentary are to identify the role of a pharmacist in LGBT health, recognize specific concerns with mental and sexual health, describe gender-transitioning pharmacotherapy, and discuss the current stance of LGBT health in pharmacy education.
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Affiliation(s)
- Erin Maxwell
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Stephanie Salch
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Monique Boliko
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
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27
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Nahata L, Chelvakumar G, Leibowitz S. Gender-Affirming Pharmacological Interventions for Youth With Gender Dysphoria: When Treatment Guidelines Are Not Enough. Ann Pharmacother 2017; 51:1023-1032. [PMID: 28660776 DOI: 10.1177/1060028017718845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Youth with gender dysphoria, also known as transgender youth, are increasingly presenting to multidisciplinary clinics within academic pediatric centers across the United States. Gender-affirming pharmacological interventions for adolescents with gender dysphoria may be used to promote positive psychological well-being and mental health outcomes. Interventions range from completely reversible to partially irreversible, based on the age and sexual maturity of the adolescent. For each intervention, dilemmas and controversies exist regarding age at treatment initiation, treatment duration, safety, and cost. Pharmacists' awareness of these considerations and interventions is important when providing evidence-based gender-affirming care to this underserved population.
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Affiliation(s)
- Leena Nahata
- 1 The Ohio State University/Nationwide Children's Hospital, Columbus, OH, USA.,2 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Scott Leibowitz
- 1 The Ohio State University/Nationwide Children's Hospital, Columbus, OH, USA
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28
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Newsome C, Colip L, Sharon N, Conklin J. Incorporating a pharmacist into an interprofessional team providing transgender care under a medical home model. Am J Health Syst Pharm 2017; 74:135-139. [DOI: 10.2146/ajhp160322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Leslie Colip
- Department of Endocrinology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Nathaniel Sharon
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM
| | - Jessica Conklin
- University of New Mexico College of Pharmacy, Albuquerque, NM
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29
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Leach C, Layson-Wolf C. Survey of community pharmacy residents' perceptions of transgender health management. J Am Pharm Assoc (2003) 2016; 56:441-445.e6. [PMID: 27245854 DOI: 10.1016/j.japh.2016.03.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/14/2016] [Accepted: 03/24/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES 1) To measure the general perceptions and attitudes of community pharmacy residents toward transgender patients and health; 2) to identify gaps in didactic education regarding transgender health care among residents; and 3) to evaluate residents' level of support for pharmacists receiving education in transgender health care. METHODS This study was a cross-sectional survey delivered online. Community residency directors were e-mailed a cover letter and a 34-question online survey. The directors were asked to forward the survey to their residents for completion within 4 weeks. Responses were anonymous with no identifiers collected on the survey. Survey responses used a combination of open-response, multiple-choice, and Likert-scale questions aimed at gathering respondents' demographic information, perceptions of managing transgender patients and the need for receiving additional education in transgender health care. RESULTS Overall, the results of the survey indicated that community pharmacy residents support integrating transgender health management into pharmacy education and recognize that the overwhelming barriers to care for these patients include discrimination and lack of provider knowledge. Significant findings include: 82.7% of community residents think that community pharmacists play an important role in providing care for transgender patients; 98.2% think that they have a responsibility to treat transgender patients; and 71.4% were not educated about transgender patient issues in pharmacy school. Only 36.2% of community residents felt confident in their ability to treat transgender patients. CONCLUSION Community pharmacy residents list discrimination and lack of provider knowledge as the major barriers to care for transgender patients. Residents do not feel confident in their ability to treat and manage transgender patients. The majority of residents were not educated about transgender patient issues while in pharmacy school and think that community pharmacists need more education in this area. Residents support integrating transgender health education into continuing education programs and pharmacy school curricula.
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Leach C, Bishop B. Pharmacotherapy Considerations in the Management of Transgender Patients: An Alternative Viewpoint. Pharmacotherapy 2016; 36:e28-9. [DOI: 10.1002/phar.1735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Caitlin Leach
- Park Pharmacy; Severna Park Maryland USA
- Towson University; College of Liberal Arts Towson Maryland USA
| | - Bryan Bishop
- University of Toledo College of Pharmacy; Toledo Ohio USA
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