Addressing gaps in transgender healthcare

Call for research submissions to pharmacology journal spearheaded by pharmacist Alice Tseng

Despite facing complex medical, pharmacological, and psychosocial challenges and needs, transgender and gender diverse people continue to be an underserved and underrepresented group. To help address gaps in medical research and healthcare, Alice Tseng, associate professor (status) at the Leslie Dan Faculty of Pharmacy is leading a call for submissions to The British Journal of Clinical Pharmacology, for original research and review articles that explore advances in trans care and future direction of the field. Published articles will contribute to an upcoming themed issue to be released March 31, 2024, the International Transgender Day of Visibility.

“Trans and gender diverse people face many gaps in research and treatment access,” said Tseng, who is also an HIV pharmacotherapy specialist at Toronto General Hospital. “In my practice I see the challenges people face and, as a clinician and researcher, there is a need to learn how to better engage with the community to provide appropriate care and also the necessary research to inform that care.”

Of particular interest to the editorial team are manuscripts that focus on pharmacological considerations of gender-affirming hormone therapy (GAHT) in combination with HIV treatment and prevention strategies, and those which address barriers to engagement in care and representation of trans and gender diverse individuals in research. 

The estimated prevalence of HIV in trans and gender diverse people is significantly higher than in what is considered to be the general population. “Access to gender-affirming care, including hormone therapy, is essential but theoretical concerns about negative interactions between antiretrovirals and hormone therapies may lead to under-prescribing of these medications, both of which are life-saving,” said Tseng.  

Along with Mona Loutfy, senior scientist and director, Women and HIV Research Program, Women’s College Research Institute, Tseng is currently leading a clinical trial on drug-drug interactions in trans women living with HIV. The study aims to inform newer antiretroviral regimens for people on gender-affirming feminizing therapy, building the evidence to show that the medications can be used effectively together.

“Exploration about drug-drug interactions with and pharmacology of antiretroviral drugs and feminizing hormones has been a priority for the trans community and their care providers,” said Loutfy. "It is encouraging that this work is gaining momentum and that this themed issue will add to our knowledge and awareness.”

Changes to dosage calculations, research and medical databases needed

When determining how much of a particular drug to give to a person, pharmacists and physicians rely on dosage calculations that are based on sex. But if someone is receiving gender affirming therapy, their physiology is undergoing change, “and so how do you approach dosing calculations that are based on sex in these circumstances? Now we are seeing that after a few months of hormone therapy, it is usually appropriate and physiologically correct to use a person’s identified gender, but this is something that not everyone is aware of and has implications for appropriate individualization of drug dosing for people.”

“Clinicians and researchers also need to be aware of how to adapt and improve institutional systems in order to reduce barriers and optimize care and research,” says Tseng. “For example, many research databases or hospital medical records systems do not provide options for specifying an individual’s preferred name or pronouns, and some systems only provide binary values for sex at birth (male/female), without additional choices for identified gender. This type of structural barrier can deter people from seeking care or participating in research studies.”

“This topic is more urgent today than ever, and we hope this call for new research culminating in the special March issue will help to stimulate and promote meaningful research in this area,” said Tseng.