Simple Steps Toward Reducing Care Disparities in the LGBTQ Community

When pharmacists are helping patients fill out forms or are in counseling sessions, they should ask patients their preferred name and pronouns, said Kelsea Gallegos Aragon, PharmD,BCACP, assistant professor of Pharmacy Practice and Administration at the University of New Mexico College of Pharmacy and pharmacist clinician at Truman Health Services, during her presentation at the American Pharmacists Association 2022 Annual Meeting & Exposition. A patient may, for example, come in for hormone therapy, but do not want to use the pronoun for the sex they are in transition to currently.

Front desk and registration staff should also address patients by the proper pronouns. “If they use the wrong pronouns—called ‘deadnaming’ in the community—are they going to be happy or feel safe?” Aragon said. “They may leave.”

“We want to make sure everyone knows it is a safe place. You want to ensure that patients understand—whatever their gender, whatever their orientation—discrimination will not be tolerated,” Aragon said.

Another way to do this is by using only gender-neutral pronouns, such as “they,” and avoiding terms such as “guys” and “gals.”

Creating a safe, comfortable environment is vital, as the LGBQT community faces more health care disparities than the average population, according to Aragon. A 2015 study found that 1 of 3 transgender people have a negative experience at a medical visit, and 23% don’t engage in medical care due to fear of mistreatment. Additionally, 50% of LGBQT individuals said they had to educate their health care provider on how to provide care to them.

During her presentation, Aragon also clarified important definitions that pharmacy staff should know.

Sex is based on the genitalia an individual was born with, while gender is “much more complex,” she noted. “It’s how you feel about who you are, your internal sense of self, and how you fit into the world and society.”

“Gender non-binary” is used for individuals who may not feel like identifying as a male or a female, while “transgender” is an umbrella term for people whose gender identity and/or expression is different from cultural expectations.

Aragon also educated APhA 2022 attendees on feminizing hormones and masculinizing hormones.

Advise patients using estrogen—including estradiol, transdermal patches, and compounded creams—that they will experience softer, less oily skin; body fat redistribution (less in the center area of the body and more towards the hips); and decreased muscle mass—even if they are exercising the same amount of time.

Patients taking estrogen will also have thin or slow growth of body or facial hair and breast growth, an A or B cup at the most, Aragon noted.

Meanwhile, testosterone monotherapy adds more fat in the center of the body, which increases patient’s risks of higher blood pressure and developing diseases such as non-alcoholic fatty liver disease.

“This is a great time to talk [with the patient] about healthy lifestyle and…exercise,” Aragon added.

Aragon concluded her presentation by sharing helpful resources, including the Office of Disease Prevention and Health Promotion Healthy People 2020 Report on LGBT Health and links to the Human Rights Campaign and the National LGBTQIA+ Health Education Center.

Reference

Aragon KG. How to provide high quality care for LGBTQ patients. Presented at: American Pharmacists Association 2022 Annual Meeting & Exposition; March 18-21, 2022; San Antonio, TX