Gender-affirming pharmacotherapy and additional health considerations: A contemporary review.

BACKGROUND: Transgender and gender-diverse (TGD) individuals in the United States face health care disparities compounded with discrimination and limited access to necessary medical services. Gender-affirming interventions have been shown to mitigate gender dysphoria and psychiatric comorbidities, yet United States legislation limiting such interventions has increased. As medication experts, pharmacists can facilitate access to care and appropriate use of gender-affirming hormone therapy (GAHT) and educate other health care providers on best practices for caring for TGD individuals in a variety of settings. OBJECTIVES: To provide pharmacists with a contemporary review of GAHT and associated medication-related concerns. METHODS: We searched PubMed for articles published until December 2022. MeSH terms such as transgender, transsexual, gender diverse, gender variant, or gender nonconforming in combination with phrases like gender-affirming care, treatment, pharmacotherapy, or hormone therapy were used to capture desired articles. RESULTS: Feminizing hormone therapy (FHT), such as estrogen and antiandrogen agents, increases female secondary sex characteristics while suppressing male secondary sex characteristics. Masculinizing hormone therapy (MHT) achieves male secondary sex characteristics and minimizes female secondary sex characteristics using testosterone. For both FHT and MHT, the choice of therapy and formulation ultimately involves the patient's treatment goals, preferences, and tolerability. GAHT has additional health considerations pertaining to renal drug dosing, fertility, cardiovascular, and cancer risks. Pharmacists may provide crucial guidance and education to both patients and health care providers regarding risks associated with GAHT. CONCLUSION: Many pharmacists feel unprepared to help provide, manage, and optimize GAHT. For many TGD individuals, GAHT is medically necessary and a life-saving treatment. Therefore, pharmacists should be provided tools to close knowledge gaps and improve their ability to care for these patients. By offering a thorough updated overview of GAHT, pharmacists can gain confidence to provide appropriate care for this increasingly visible population.

COVID-19 pandemic vaccination preparedness strategies for independent community pharmacies.

OBJECTIVE: This study aimed to determine independent community pharmacist preparedness for coronavirus disease 2019 (COVID-19) vaccination and to identify strategies for COVID-19 pandemic vaccination implementation in Pennsylvania. METHODS: This study used a complementary mixed-methods approach to recruit independent community pharmacists to participate in an electronic survey and 2 virtually conducted focus groups before the availability of the first COVID-19 vaccine. Information was gathered and compiled into 5 topic areas: (1) workflow, (2) resources, (3) staff and patient safety, (4) communication, and (5) documentation and training. Data collection occurred between October and December 2020. Survey data were analyzed using descriptive statistics. Focus group discussions were audiorecorded and transcribed. A directed, content analysis was conducted to identify strategies for each topic area, and supporting quotes were selected. RESULTS: A total of 88 and 11 independent community pharmacists participated in the survey and focus groups, respectively. Because of the small size of most independent pharmacies, participants recommended working with community partners to support off-site mass vaccination clinics. Leveraging partnerships with community organizations and universities could be used to support staffing for vaccination efforts. Using an appointment-based immunization model was identified as one tool to optimize patient and staff safety during the pandemic. Pharmacists suggested using existing scheduling tools and text messaging and automated phone calls for second-dose reminders. Finally, independent pharmacists recommended further training and process improvements to support vaccine documentation and transmission to the Pennsylvania Statewide Immunization Information System. CONCLUSION: Recommendations from this study were used to support planning and preparation for COVID-19 vaccinations across Pennsylvania. Incorporation of pharmacists' ideas and recommendations on pandemic vaccination implementation is an important strategy to efficiently expand vaccination administration during pandemics.