Pharmacist Involvement Has Positive Impact on Patients Receiving Gender Affirming Care

Pharmacist inclusion in an endocrinology clinic led to positive outcomes for patients receiving gender-affirming hormone therapy, according to a poster¹ presented at the American Society of Health-System Pharmacists 2022 Midyear Clinical Meeting, held December 4 to 8 in Las Vegas, Nevada.

Transgender individuals experience a “significantly higher burden” of health inequity, as well as higher incidences of mental illness and suicide attempts. Although there is a significant and urgent need for knowledgeable and culturally competent health care providers, gaps in gender-diverse education remain.

Across other disease states, there has been a demonstrated benefit of pharmacist involvement in patient care, in areas such as patient education, adverse event monitoring, and medication access assistance. In the current study, researchers evaluated an exploratory quality improvement initiative that added a pharmacist to the multidisciplinary team managing gender hormone affirming therapy.

Patients aged 16 or older identifying as transgender, gender nonconforming, or gender nonbinary who were receiving gender affirming care at an endocrinology clinic were included in prospective pharmacotherapy evaluations. After patient consent was acquired, a pharmacist met with each patient, alongside the physician, during their endocrinology visit.

During these visits, the pharmacist sought to identify opportunities to optimize medication regimens, medication adherence, and medication access, all of which were documented in the electronic health record. The benefit of pharmacist co-management of this care was determined as the percent of patients achieving their hormone goals, recommendation acceptance rate by the endocrinologist, types of interventions, and incidence of adverse events and serious adverse events.

A total of 20 patients were included in the cohort (mean age, 30 years; mean therapy duration, 1.6 years). Thirteen patients met guideline directed target hormone levels for their gender identity, and 16 patients met their goals of care. Four patients were seen twice, two of whom required pharmacist intervention for medication optimization.

The prescriber acceptance rate of pharmacist recommendations was high; only 1 instance was documented where the prescriber preferred oral testosterone over the topical alternative. The most frequent interventions made by the pharmacist was drug interaction management, adverse event avoidance, and adherence strategies.

Study limitations included the small sample size, short study duration, poor patient compliance with requested laboratory drawings before the appointment, and the inability of the pharmacist to attend all in-person visits.

“This study was able to demonstrate that a pharmacist in an endocrinology clinic was able to make an impact,” the researchers concluded. “These interventions assisted patients in achieving goals of gender affirming care.”

Reference

1. Sowers MD, Madduri R, Lind R, Weinstein S, Philips N. Evaluation of pharmacist co-management of gender affirming hormone therapy in an endocrinology clinic (Access-GAHT). Presented at: American Society of Health-System Pharmacists 2022 Midyear Clinical Meeting and Exhibition; December 4-8, 2022; Las Vegas, NV. Poster 8-077.