New curriculum focuses on caring for transgender patients

PharmD for Pharmacists primary care course helps pharmacists provide inclusive care

Many transgender people have had negative experiences with the health care system, including discomfort, stigma, and discrimination. Government documentation or medical records might not match a person’s gender identity and/or expression, or they may face financial or socioeconomic barriers that make accessing care – usual medical care and particularly trans-specific or gender-affirming care – more difficult.

According to the 2021 Canadian census, 0.3 per cent of people in Canada are transgender or non-binary, a significant population that is currently underserved by the health care system. Pharmacists are well-suited to help provide this care, yet many practising pharmacists may not have training or experience caring for trans patients.   

Jennifer Lake, assistant professor – teaching stream at the Leslie Dan Faculty of Pharmacy, is helping to change that. As an instructor in the primary care course in the PharmD for Pharmacists program, she recently added a new unit that is focused on transgender health. The unit is being taught for the first time this semester.

“The gaps in care for people who identify as trans or non-binary are so huge, even a little improvement in providing care means we’re going to have real health gains,” says Lake. “I think most pharmacists and pharmacy students want to provide better care, but it can be overwhelming to know where or how to start. Hopefully, the information in this unit can make it a little bit easier.”

With trans issues becoming more prominent and transphobia and discrimination a regular occurrence, Lake wanted to add the new unit to help pharmacists familiarize themselves with how to provide culturally competent care for trans patients and navigate some of the challenges these patients may face in accessing health care.

Lake says that the session starts with a discussion of language and terminology, the importance of using correct pronouns and avoiding misgendering people. She also covers barriers to care that trans patients face, including challenges with government documents and medical records, and the pharmacist’s role in providing gender-affirming care through hormones.

“I don’t consider myself to be a trans health expert, but I’m an expert in patient care, medications, and helping patients achieve their health care goals,” says Lake. “I think that gives my students permission to understand that even if they are not an expert in this area and they have never done this before, they can still become confident in providing excellent care to their transgender patients.”

“Caring for trans people is within the scope of primary care”

Dr. Edward Kucharski, assistant professor in U of T’s Temerty Faculty of Medicine and co-author of a clinical guide on 2SLGTBQ+ health, says that every primary health care provider should be comfortable and competent in providing care to trans patients.

“Caring for trans people is within the scope of care for both primary care and pharmacy, and we have the knowledge and skills to do so,” says Dr. Kucharski. “Trans people shouldn’t have to go to a specialized centre to receive care. They should be able to get care anywhere.”

Dr. Kucharski, who has also cared for trans patients as a family physician for nearly 20 years, also provides training for primary care providers. While much of a pharmacist’s role in caring for trans people relates to hormones and managing those medications the same as they would any other, Dr. Kucharski emphasizes that pharmacists can provide a welcoming environment with signs and banners and use a patient’s identity and pronouns, instead of what may be listed on official documentation. And when mistakes do happen, simply apologize and move forward.

“There are certain structures that have traumatized the trans community when it comes to health care, and we have to do a better job of welcoming trans people into care,” says Dr. Kucharski. “After being in this sector for almost two decades, we still have a long way to go, but we have made remarkable progress. Training in trans health is so important for providers who haven’t been working with this community to raise more awareness and help these providers become more culturally competent.”

Lake hopes that the new addition to her course will help pharmacists become more aware of trans health and think about how they can make their practice more welcoming, resulting in better care for trans patients.

“As pharmacists, we can try to help people – especially those who are in underserved populations – have a better journey through the health care system,” she says. “These small things can help reduce some of the stigma in health care, and that will help their health overall.”