Dalhousie study examines how pharmacists can help improve access to gender-affirming care

A new peer-reviewed study from Dalhousie University has found that pharmacists' scope of practice can be used to provide gender-affirming care — health care that supports a person's gender identity.

Despite the documented benefits of receiving this care, many gender-diverse people are unable to access it, said the study, which was published on Jan. 9.

For example, adolescents in Canada reported spending more than a year on average seeking gender-affirming medical care, according to a study of youth at 10 health clinics across Canada. They then faced an average wait time of 269 days after receiving a referral.

Pharmacists can provide and help improve access to gender-affirming care, said study co-author Robyn Walter, a third-year doctor of pharmacy student at the university in Halifax, N.S. 

"Pharmacies are located everywhere," she said.

Prescribing and adjusting medications are areas where pharmacists could contribute, the study found.

"Prescribing … is becoming a lot more common, especially here in Nova Scotia," said another co-author, Sophie Gillis, who is also a third-year doctor of pharmacy student. "We [pharmacists] have a very expansive scope of practice."

Transgender and non-binary patients taking hormone therapy, for instance, can experience changes in body composition and other effects, Gillis said.

"Pharmacists as a result might have to adjust existing medications that might not be related to gender-affirming care."

According to the Nova Scotia College of Pharmacists, people in the profession were first granted the authority to prescribe drugs in 2011. 

Pharmacists can renew prescriptions and prescribe adaptations and substitutions, according to the college's standards of practice.

Pharmacists could also play a role in educating patients on the expected effects of their treatments and in monitoring them for side-effects, the study said.

"A lot of times, medications might not provide the desired effect in the timeline that the patient was necessarily expecting," Gillis said.

Pharmacists could also provide information on topics like self-injection techniques for hormone therapy, Gillis said.

In addition, there are things pharmacies could do that wouldn't require policy or regulatory changes, Walter said, citing as an example stocking gender-affirming equipment like chest binders or binding tape in storefronts. 

Overall, "there is a great opportunity to … improve access to gender-affirming care through community pharmacies," Walter said, adding that there's more research to be done on the topic.