Transgender is a broad term for all people who do not identify with or choose not to conform to the gender roles assigned to them by society based on their biological sex—in other words males who do not look, act or feel what society calls “masculine” and females who do not look, act or feel what society calls “feminine.”
Sex: Male, female, or Intersex, depending on one’s primary sex characteristics.
Intersex: People born with an anatomy that someone else decided is not standard for male or female.
Gender: Socially and culturally constructed roles ascribed to males and females. These roles, which are learned, changed over time and vary widely within and between cultures as well as from individual to individual.
Gender Identity: One's sense of belonging to a particular gender.
Gender Expression: the way in which someone conveys gender attributes.
Drag: Gender performance, often for entertainment purposes.
GenderQueer: An individual whose gender identity lies outside the gender binary system of male and female. This individual may be fluid with their gender expression.
Gender Neutral Pronouns: and may use gender neutral pronouns (such as *sie, hir, hirs, hirself* or *zie, zir, zirs, zirself*) or choose to use the pronoun closest to the end of the masculine or feminine spectrum they are presenting.
MYTH: All transgender individuals want or have had sex reassignment surgery.
FACT: Actual or desired surgical status is separate from one’s gender identity. Some transgender individuals feel “complete” once they have had surgery, while others opt to not have surgery because of limited funds and/or lack of medical insurance coverage, medical complications, or because they are dissatisfied with current technological limitations.
MYTH: Transgender individuals go from either male-to-female or from female-to-male.
FACT: “Transgender” is an umbrella term, which includes people who do not conform to gender stereotypes, roles, and expectations. Some transgender individuals appreciate an androgynous or gender queer identity. Many drag monarchs (kings and queens), cross-dressers, butch women and feminine men also consider the transgender community home.
MYTH: Being transgender is a birth defect that can be corrected through hormones and surgery.
FACT: While some transgender individuals believe this, some believe that their transgender identity is a gift or a blessing. Some transgender individuals also feel that there isn’t anything defective about their transgender identities.
Eads, a transgender man diagnosed with ovarian cancer, was turned down for treatment by two dozen doctors out of fear that treating such a patient would hurt their reputation. By the time Eads received treatment, the cancer was too advanced to save his life.
The core symptom of gender identity disorders is gender dysphoria, literally being uncomfortable with one's assigned gender.
This feeling is usually reported as "having always been there" since childhood, although in some cases, it appears in adolescence or adulthood, and has been reported by some as intensifying over time.
Since many cultures strongly disapprove of cross-gender behavior, it often results in significant problems for affected persons and those in close relationships with them. In many cases, discomfort is also reported as stemming from the feeling that one's body is "wrong" or meant to be different.
Many transgender people do not regard their cross-gender feelings and behaviors as a disorder.
Some trans people object on the grounds that there may be a physical cause, as suggested by recent studies about the brains of transsexual people. Many of them also point out that the treatment for this disorder consists primarily of physical modifications to bring the body into harmony with one's perception of mental (psychological, emotional) gender identity, rather than vice versa
In order to access “treatment”—meaning hormones and, perhaps, surgery—you first have to be diagnosed. But calling trans people sick creates the same stigma gay/lesbian/bisexual people faced for decades.
Developed in the early 1990s, the Health Law Standard (HLS) takes an entirely different approach from the medical-model paradigm of the original SOC.
Informed consent approach, and is written in the form of a contract between client, doctor, and legal spouse. Clients sign the HLS, indicating they understand and take full responsibility for all risks inherent in the transition process.
Once they have signed the HLS, they may access hormones and any surgical procedures related to transition, bypassing the therapeutic process altogether if they so choose.
guidelines outlined in Gianna Israel and Donald Tarver's classic 1997 book "Transgender Care".
Several LGBT health clinics in the United States (e.g. Tom Waddell in San Francisco, Callen Lorde in New York City, Mazzoni in Philadelphia) have developed “protocols” for transgender hormone therapy following a “harm reduction” model which is coming to be embraced by increasing numbers of providers.
In their 2005 book Medical Therapy and Hormone Maintenance for Transgender Men , Dr. Nick Gorton et al suggest a flexible approach based in harm reduction, “Willingness to provide hormonal therapy based on assessment of individual patients needs, history and situation with an overriding goal of achieving the best outcome for patients rather than rigidly adhering to arbitrary rules has been successful.”
At the most fundamental level, their general health issues are similar to those of all people. In terms of physiology and pharmacology, there is no evidence to date that suggests that biology differs by sexual orientation.
There is evidence to suggest that there are certain health behaviors and health conditions that may be more prevalent among LGBT which the pharmacist may be more likely to encounter in this population
Female-to-male transgender persons may retain female body parts and continue to produce female sex hormones which may interfere with exogenous testosterone or other medications.
Male-to-female persons who have had sex confirmation surgery will still retain the prostate gland, and this may be overlooked during physical exams.
Female-bodied FTMs often resist gynecological care because of body dysphoria and the discomfort of being male and entering a space dedicated to female care.
Both FTMs and MTFs may have difficulty finding health care providers who are knowledgeable and sensitive to their unique issues and bodies, thus transgender people may be more likely to have undiagnosed conditions, or chronic conditions that are not fully treated.
HIV infection reported in MTF’s and men who have sex with men (MSM), though most government reporting agencies have not distinguished between the two populations.
Recent systematic review of the literature found 29 studies with HIV+ rates ranging from zero to 68%, and reported that the rate of new infections was higher for MTFs than other groups.
Rates of HIV infection among FTMs were reported as much lower (0% to 3%), but these figures represented only five studies.
Other studies have reported that the rate of risky sexual behaviors by FTMs may be as high or higher than those of MTFs and that FTMs are less likely to get tested for the virus.
Role of Pharmacists when working with LGBT Clients
The American College of Clinical Pharmacy, the American Pharmacists Association and the American Association of Colleges of Pharmacy have all recognized the importance of cultural competence.
Cultural competency as it pertains to lesbian, bisexual or transgender populations requires awareness of population-specific issues and concerns, corresponding sensitivity to these issues and ultimately, the provision of services that evince such awareness and sensitivity.
Awareness might mean remaining cognizant that not all people are heterosexual and that some women identify as lesbian or bisexual or transgender, regardless of appearance, age, race or geographic location.
For instance, while large cities may have highly visible lesbian and gay communities, in reality, sexual minority women and transgender persons reside in large and small, urban and rural communities all over the United States. Data from the 2000 census showed that there are same-sex couples living in 99% of counties in the United States.
Transgender persons often struggle with others accepting their self-identified gender as legitimate—a struggle that pervades both personal and professional interactions. Pronoun usage, preferred name usage.
Confidentiality must be strictly adhered to, as not all lesbian, gay bisexual, or transgender clients are open about their identities, and carelessness could bring about harm. Keep records secure from those who do not need personal information, and respect the needs of clients for privacy and confidentiality.
Do not assume someone is heterosexual or assume someone is LGBT based on stereotypes.
Become familiar with population-specific resources.
Advocate for inclusive policies, work to change policies and procedures that are discriminatory, or create guidelines for the provision of culturally competent care, and/or educating staff and coworkers.
Marketing materials, brochures, ways services are introduced. Are they representative of the diversity of the populations within the service area? Will trans people feel like the advertised facility is a comfortable place for them? How is this communicated? What is the current reputation in Trans community? Is there a need to address past negative experiences?
Display health info, magazines, posters, and other decorations that reflect the faces and interests of clients served. Staff should also be representative of clients served. Consider posting a written non-discrimination policy that gender identity and gender expression.