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Erin D Knox, PharmD, BCPP
Director of Experiential Pharmacy Education
UCI School of Pharmacy & Pharmaceutical Sciences

“The Best part about being a girl is now I don’t have to pretend to be a boy.”

Dr. Jennifer Moore began her keynote presentation at AAPP’s 2023 Annual Meeting with this impactful statement, preparing the audience for a discussion on transgender care across the continuum. Delivered with “kindness and compassion”, the learning objectives highlighted components of the transgender experience, including barriers to care as well as multi-disciplinary approaches to care. Delivered with “empathy and respect”, this conversation led the audience through the longitudinal experiences of transgender youth in the U.S.

To illustrate the relevance of this topic, Dr. Moore began by providing estimates of the transgender (TG) population in the U.S., illustrating that those under 25 years old make up 43% of the TG population.1 Definitions of relevant terms were provided, and an anonymous quote was shared: “Gender is between the ears. Sex is between the legs.” Relevant terminology was outlined, including biological sex, which is based on genitalia noted at birth, gender identification, a self-determined feeling or perception, and gender expression, how one chooses to present to the world.2 Gender incongruence, a feeling of mismatch between biological sex and gender identify, may result in significant psychological distress, often intensifying with the onset of puberty.3

To better understand the TG experience, Dr. Moore reviewed common stressors, including internal conflict around sense of self, while emphasizing that being TG is not a choice.4 Studies around mental health in the TG are lacking, with many reporting limited or non-representative sampling methods.5 However the literature describes the TG population as being more likely to experience mental health challenges, including having five-times higher incidence of suicidal ideation or attempts and depression or anxiety being 2.3 times more likely than the cisgender population.5 Unfortunately, many individuals identifying as TG report wanting counseling, but are unable to attain appropriate care due to discrimination or denials of care.6

Dr. Moore reviewed studies on TG populations describing increased suicide rates compared to the general population7, and TG youth reporting four times more physical assaults than cisgender populations.8 Conversion therapy (CT) controversies were addressed, including opposition to CT from medical and mental health groups and laws prohibiting these interventions in 20 U.S. states.

Barriers to care were addressed by Dr. Moore, including:

  • Legal barriers
  • Anti-TG legislation
  • Lack of legal protections
  • Insurance coverage restrictions
  • Paucity of comprehensive care centers
  • Limitations in education or experience caring for TG individuals
  • Financial burdens

As Dr. Moore continued to share information, medical organization clinical guidelines were reviewed, including timelines on when to begin care, with a focus on listening to the child and providing psychological care as needed. Psychosocial support was emphasized, particularly as the TG individual considers pharmacological agents, such as puberty blockers, and medical interventions or surgical procedures.9

The multi-disciplinary care team is vital per Dr. Moore and involves pharmacists at every step, including pharmacological selection, dosing, monitoring, therapeutic effects, and side effect management.10 Long term relationships with patients and providers can be life-altering and lifesaving. The presentation ended with this impactful statistic: one supporting adult can reduce the rate of suicide by 42% 11, emphasizing that healthcare providers can truly be the one to save a life.


  1. Flores, A. R., Herman, J., Gates, G. J., & Brown, T. N. (2016). How many adults identify as transgender in the United States? (Vol. 13). Los Angeles, CA: Williams Institute.
  2. Kyriakou, A., Nicolaides, N. C., & Skordis, N. (2020). Current approach to the clinical care of adolescents with gender dysphoria. Acta Bio Medica: Atenei Parmensis, 91(1), 165.
  3. Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., ... & T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869-3903.
  4. Frigerio, A., Ballerini, L., & Valdes Hernandez, M. (2021). Structural, functional, and metabolic brain differences as a function of gender identity or sexual orientation: a systematic review of the human neuroimaging literature. Archives of sexual behavior, 50(8), 3329-3352.
  5. Russell, D. H., Hoq, M., Coghill, D., & Pang, K. C. (2022). Prevalence of mental health problems in transgender children aged 9 to 10 years in the US, 2018. JAMA network open, 5(7), e2223389-e2223389.
  6. Morris, E. R., Lindley, L., & Galupo, M. P. (2020). “Better issues to focus on”: Transgender Microaggressions as Ethical Violations in Therapy. The Counseling Psychologist, 48(6), 883-915.
  7. Thoma, B. C., Salk, R. H., Choukas-Bradley, S., Goldstein, T. R., Levine, M. D., & Marshal, M. P. (2019). Suicidality disparities between transgender and cisgender adolescents. Pediatrics, 144(5).
  8. Flores, A. R., Meyer, I. H., Langton, L., & Herman, J. L. (2021). Gender identity disparities in criminal victimization: National Crime Victimization Survey, 2017–2018. American Journal of Public Health, 111(4), 726-729.
  9. Lee, J. Y., & Rosenthal, S. M. (2023). Gender-Affirming Care of Transgender and Gender-Diverse Youth: Current Concepts. Annual Review of Medicine, 74.
  10. Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., De Vries, A. L. C., Deutsch, M. B., ... & Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health, 23(sup1), S1-S259.
  11. American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American psychologist, 70(9), 832-864.
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