Royal Pharmaceutical Society

Trans-inclusive healthcare: A pharmacy perspective

Nathan BurleyBy Nathan Burley, Advanced Sexual Health Pharmacist, NHS Greater Glasgow and Clyde

Understanding Gender Identity and Transgender Healthcare in Pharmacy

Navigating gender identity as a pharmacy professional can seem like a minefield but in reality, it is quite straightforward.

Gender dysphoria describes the sense of unease that a person has because of a mismatch between their biological sex (physical/physiological attributes) and their gender identity (societal construct/behaviours/appearance). This can lead to transitioning.

Gender-affirming hormone treatment is the typical mainstay medical intervention – taking masculinising hormones like testosterone for trans men and taking oestrogen-based hormones for trans women. “Top” surgery such as the removal or construction of breast tissue and “bottom” surgery like the creation of a neo-vagina or penis (phalloplasty) can also be performed.

“Trans woman” is the term given to a person assigned male at birth but now identifies and presents as a woman. “Trans man” is the term given to a person assigned female at birth and now presents as a man. Someone “non-binary” does not conform to the male/female gender categorisation and instead may present as gender fluid.

What does trans-inclusive healthcare have to do with pharmacy?

The main consideration is communication. Using a patient’s preferred title, name, or pronouns is important in the same way that someone called “Alexander” may be called “Sandy” or “Elizabeth” may prefer “Betty”.

Whether someone is trans can be relevant in the case of urinary tract infection (UTI). If a cis man presents with symptoms of a UTI there is greater clinical concern due to length of the urethra and need for increased duration of antibiotics. Therefore knowing if a trans man has had a phalloplasty is clinically important as there is a greater risk of complication if so, but if they haven’t then a shorter course of antibiotics can be given in most circumstances.

In the same vein, if a trans man presents for emergency hormonal contraception (EHC) they may be physiologically at risk of getting pregnant and should have EHC provided if otherwise appropriate and indicated.

There are also considerations for interpreting blood results. Therefore building a rapport with patients is important to get the full picture as with any clinical consultation.

Tips for respectful and inclusive transgender healthcare conversations

  • If you find using pronouns makes the consultation or discussion clunky simply using someone’s preferred name can make it easier.
  • Trans people are generally happy to discuss relevant information like surgeries or medical treatments when explained that it is relevant for clinical decision-making and providing the best possible care.
  • Mistakes can happen with terminology – don’t get hung up on it, apologise, reflect, and move on.
  • Refer to local guidance for interpretation of blood results such as creatinine values especially where results sit near cut-off ranges for drug dosing in varying renal function.

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