Therapeutic Issues Associated with Gender-Affirming Hormone Therapy in Transgender Individuals: A Systematic Review...

Community pharmacists play an increasingly important role in the care of transgender individuals receiving gender-affirming hormone therapy (GAHT). However, the content of structured pharmaceutical consultations tailored to this population has not yet been clearly defined. This systematic review aimed to identify therapeutic issues relevant to community pharmacy practice in order to inform the development of structured pharmaceutical consultations. A systematic literature review was conducted in accordance with the PRISMA 2020 Statement. The review question was structured using the PICo framework, with transgender individuals as the population, treatment-related issues associated with GAHT as the phenomenon of interest, and community pharmacy practice as the context. Electronic searches of Medline, Google Scholar, and APA PsycINFO were performed on 17 July 2024. Studies involving transgender adolescents or adults receiving GAHT and reporting therapeutic effects, adverse events, monitoring requirements, or medication-related issues were eligible. Two reviewers independently screened the studies and extracted data using a standardized form. Owing to the heterogeneity of study designs, the findings were synthesized narratively according to therapeutic domains relevant to community pharmacy practice. Among 755 screened records, 116 articles met the inclusion criteria. Seven therapeutic domains relevant to pharmacist-led consultations were identified: cardiovascular and cardiometabolic effects, dermatologic effects, gynecologic effects, musculoskeletal effects, biological and pharmacological effects, psychiatric effects, and other adverse effects or specific clinical situations. The evidence highlighted treatment-specific monitoring needs, medication-related risks, fertility and contraceptive considerations, laboratory monitoring requirements, drug-drug interactions, and mental health outcomes. Community pharmacists may contribute to the monitoring and optimization of GAHT, adverse effect management, patient education, fertility and contraceptive counseling, pharmacovigilance, and interdisciplinary collaboration within the scope of their professional practice. These findings provide an evidence-informed basis for the future development of structured pharmaceutical consultations tailored to transgender individuals.