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Every pharmacist has a role to play in supporting trans people

Strides towards diversity and inclusion in pharmacy practice have been widely welcomed by the profession. However, there are disparities in the public support for, and allyship with, some minority groups, says Scott Rutherford

Trans people, who are protected by the Equality Act 2010 regardless of whether they have undergone or are undergoing transition or not, are the subjects of a culture war perched against a backdrop of systemic discrimination, particularly within healthcare.

Before much of the misinformed media coverage and associated controversy, trans people, and people within the lesbian, gay, bisexual, and trans (LGBT+) community as a whole, were already less likely to access healthcare due to fear of discrimination.

Read more: How to feel more confident dealing with transgender patients

According to the charity Stonewall, over a third of trans people avoid seeking treatment, and there are a number of likely contributing factors.

Further, nearly half of trans people have experienced "inappropriate curiosity" from healthcare staff and over a quarter have been outed without consent.

Meanwhile, more than 60% of trans people have received care from healthcare staff that they feel had a poor understanding of their specific needs. One in five trans people have been pressured by healthcare staff to access services that constitute a form of "conversion therapy".

The institutional discrimination against trans people within healthcare in the UK is founded on the fact that the NHS and its systems were not designed to include people who are not cisgender (where the gender somebody identifies as corresponds with the sex they were assigned at birth).

Read more: LGBT+ in pharmacy: pride despite prejudice

For example, to change the gender marker on their patient record, trans people must be given a new NHS number and have their medical information manually transferred to their new record within five working days.

This is an arduous process that can lead to people being excluded from cervical, breast, and prostate screening, potentially contributing to health inequalities.

The education and training of healthcare professionals has also poorly equipped many to manage the care of trans people.

Pharmacists are not exempt from this. A common experience is the refusal of care to trans men and non-binary people assigned female at birth who are trying to access emergency hormonal contraception in community pharmacies.

Pharmacists have the right to refuse treatment where clinically or ethically inappropriate.

However, I believe that to refuse based on a lack of information or understanding is not acceptable considering the availability of clear guidance from the Faculty of Sexual and Reproductive Health (FSRH) on regular and emergency hormonal contraception.

With waiting lists for first appointments at gender identity clinics of several years, and a gatekeeping approach to gender-affirming healthcare, some trans people are forced to obtain gender-affirming therapy outside of the NHS.

For some people, this involves accessing expensive private care from inside or outside the UK, which is unlikely to be continued by the NHS.

For other people, this involves "DIY" or "self-medicating", with hormones or other hormonally-active drugs bought online or shared with others. This has potential legal implications, especially for people in possession of testosterone, which is a Schedule 4 Controlled Drug, in addition to clinical risks.

Read more: LGBTQ+ charity launches free resource on inclusive pharmacy practice

These medicines may not be quality assured, and many of the medicines obtained in this way are injectables, posing a risk of injury and infection, especially when considering the potential for needle-sharing.

This method of accessing gender-affirming hormonal therapies lacks the appropriate clinical review and monitoring, such as the regular measure of a patient’s haematocrit and haemoglobulin levels when undergoing testosterone therapy.

It is time for pharmacy, and the healthcare system, to see beyond the vitriol directed at trans people and instead understand the inequalities that this group faces.

While reform of the gender identity services will take time, every pharmacist has a role in supporting trans people to have safe and healthy lives.

Consider how your practice could better include and support trans people; evaluate your policies, make your allyship visible, and most importantly, educate yourself.

Scott Rutherford is the President of the Pharmacists' Defence Association LGBT+ Network


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