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How can Pharmacists improve gender-affirming care? An insider’s perspective

Updated: Jul 24, 2023

Editor’s note: Maeleigh Tidd continues to explore the role of pharmacists in the provision of gender-affirming care for LGBTQ+ people, and return to the Pharmaceutical Inequalities series with an interview of Dolyn Salm, a transgender pharmacy student at the University of Wisconsin Madison School of Pharmacy. They discuss Dolyn’s experiences of navigating the US healthcare system during his transition, and his views on how pharmacists can be better prepared to support the needs of LGBTQ+ patients. The Pharmaceutical Inequalities series is funded by the Holtz Center and the Evjue Foundation.


Right: Dolyn Salm, DPH-3, UW-Madison School of Pharmacy

I had the opportunity to sit down with one of the only current transgender pharmacy students at the University of Wisconsin Madison School of Pharmacy, Dolyn Salm, to understand his experiences navigating the healthcare system throughout transitioning, while also gathering his perspective on pharmacy/pharmacists’ roles in gender-affirming care. Dolyn Salm is an upcoming third-year pharmacy student who enjoys book-clubbing with friends and spending time with his two cats and fiancée. Dolyn is open about his identity at school and hopes that being visible empowers others to be their most true selves.


For the first part of the interview with Dolyn, I sought to understand his experience navigating the healthcare system during his transitioning. He acknowledged right from the beginning that his experiences are/were quite different than most transgender individuals, in that acquiring the tools he needed for his medical transition has been “super easy and accessible”. Dolyn, being a student at the university (undergrad and PharmD), has the opportunity to utilize University Health Services (UHS), where they provide an array of services to students for free (paid by segregated fees), including mental health and gender-affirming care. He shared that he started his journey at UHS seeing a therapist because he was “noticing some dissonance with my identity and everything”, which lead to easily accessing HRT and connections to surgeons to perform gender-affirming surgery. Dolyn mentioned that this kind of access to HRT and surgery is not always this easy. He shared: “I know a lot of my trans friends have had it really hard accessing HRT and a physician that will support their transition without gatekeeping. They often require a long process of seeing a therapist, with certain qualifications, for a certain amount of time, to sign a letter(s) of a diagnosis of gender dysphoria or verify that you are in need of these services”.


“I know it really varies, accessing and affording gender affirming care.”


When asking Dolyn about some of the barriers he faced during his transition, he alluded to insurance being the biggest – outside of societal and social barriers. Dolyn transitioned during the height of the coronavirus pandemic (planned prior), which caused additional challenges throughout the process. He stated, “I had prior authorizations for my surgery that ended up expiring due to delays from COVID, and it seemed like I was the only one advocating for myself to get it figured out how to move forward with the procedure. I was the one calling the insurance company and navigating the process/communication between them and the care team, which seems to me would be their job.” Insurance is a common barrier for many in healthcare, Dolyn was fortunate that his insurance barrier was communication-based and not related to coverage. He did acknowledge that even being faced with this barrier, “not everyone understands the healthcare system enough to successfully advocate for themselves in those situations, which could be a true obstacle in receiving the care you need.”


I followed up by asking what his experience has been like at the pharmacy, when accessing gender-affirming care there. He mentioned that his prescriptions have to be filled with his legal name, which he hasn’t changed yet, however, his name in use is in his file and is in parentheses on his prescription labels to standout that that is what he goes by.


“There have been slip ups where they use my dead name to address me, but since my name in use is derived from my legal name, I think it is a little bit easier for them. When I go and pick up prescriptions, I will say I’m here to pick up for Dolyn Salm, and it’s pretty easy for them to find my file and prescriptions.”


Outside of the occasional slip up in using his dead name, barriers at his pharmacy have been minimal. He mentioned that there have been little things like automatic refills not lining up with his injection days, but all-in-all his pharmacy has beenculturally competent to me, my name and pronouns, and my transition”.


Final questions of the interview consisted of understanding how Dolyn is learning to become a competent pharmacist through pharmacy school here at UW-Madison, and his perspective on the pharmacy/pharmacists’ role in providing gender-affirming care.


Dolyn is still early on in his program, but to-date it has focused primarily on the drugs themselves rather than the provisions of care. He shared that one of his first-year courses on the behavioral aspects of pharmacy spent a lot of time on how to provide competent and sensitive care, while also discussing disparities of health care. He, and his classmates, have required professional development hours throughout the school year where one or two have been on LGBTQ+ 101 topics.


When asking him what he wished was given more focus on in the pharmacy curriculum to help him, and others, provide care to the LGBTQ+ community in their future practice, he stated:


“I think for me, I would like more focus on interprofessional communication and collaboration; how to communicate not only with our patients but providers, therapists, social workers, insurance companies. LGBTQ+ or not, pharmacists are communicating with a vast range of healthcare professionals, and if we know how to communicate and collaborate effectively, we can be true advocates for our patients.”


To wrap up, Dolyn shares that a first step to providing inclusive patient care starts with getting names and pronouns right. They conclude with, “an inclusive pharmacy starts with culturally competent and sensitive pharmacists and pharmacy staff, which is developed by attending workshops, seminars, continuing education, etc.”.

 

Feature image source:  Fitchburg Family Pharmacy Facebook page. Fitchburg Family Pharmacy is a local pharmacy here in the Madison, WI area that not only displays LGBTQ+ pride but offers a safe space in providing gender-affirming care to the community.

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