Delivering Gender-Affirming Hormone Therapy in Pharmacy
Not Just Possible, But Essential
We’re diving into hormone replacement therapy this month — this article explores gender-affirming hormone therapy (GAHT) through two real-world case studies — one transfeminine and one masculine non-binary — you'll deepen your understanding of hormone replacement therapy journeys, the pharmacist’s role in care continuity, and the importance of affirming, patient-led support.
This article is accompanied by a CPD module, hosted on lrnrx, which explores these topics in detail through interactive learning built with Articulate Rise. Whether you're a pharmacist, intern, student, or assistant, this course will help you build on your values of care, dignity, and inclusion.
When we talk about hormone therapy in pharmacy, we often default to the familiar: menopausal HRT, testosterone for hypogonadism, or contraception. But tucked beneath those PBS codes and prescribing patterns is another reality — a deeply personal and essential form of care for thousands of transgender and gender-diverse people across Australia: gender-affirming hormone therapy (GAHT).
Unlike standard endocrine protocols, GAHT is as much about identity, autonomy, and affirmation as it is about oestradiol, testosterone, or serum levels. It’s not just about balancing hormones — it’s about restoring agency and aligning bodies with self-defined truths. And pharmacists, whether they realise it or not, play a critical role in how safe, supported, and seen a person feels on that journey.
The Feminising Journey: A Case in Patience and Complexity
Take the case of a 29-year-old transgender woman who began feminising hormone therapy in 2019. Like many transfeminine patients, she started with oral oestradiol and cyproterone acetate, a common regimen in Australia aimed at both oestradiol supplementation and testosterone suppression. Her journey, however, was anything but linear.
Over six years, her therapy evolved in response to side effects, medication shortages, and personal goals. She trialled transdermal patches, which didn’t absorb well for her. She later opted for oestradiol implants, valuing their long-acting stability. During a trial of oestradiol-only suppression (a method sometimes suitable for those wishing to avoid anti-androgens), her testosterone levels rebounded, and cyproterone was reintroduced.
This case underscores a key reality: no two journeys are the same. Feminising therapy is not plug-and-play. Each formulation choice — oral vs patch vs gel vs implant — carries implications for tolerability, risk, access, and preference. Pharmacists must support nuanced decision-making and remain agile when patients experience physical, emotional, or logistical barriers to care.
The Masculinising Journey: Agency in Action
Now consider a different path — a 24-year-old non-binary person who began masculinising hormone therapy using testosterone undecanoate injections. Their goal was not full binary transition, but rather moderate masculinisation: some voice deepening, body hair, and redistribution of body fat. After 18 months, they felt they had achieved what they needed — and chose to taper and stop.
This is a crucial scenario that challenges normative ideas about GAHT. There’s an assumption — often unstated but ever-present — that trans people begin hormones for life. But for many, particularly non-binary folks, GAHT is a tool, not a destination. It’s used for specific outcomes, for specific periods of time. Discontinuation isn’t regret — it can be resolution.
In this case, the pharmacist’s role didn’t end with the last injection. They remained involved, offering support for contraceptive needs, mood shifts, and general primary care engagement. They ensured that post-therapy care was just as affirming and clinically sound as initiation.
This highlights something all pharmacists need to internalise: we don’t just dispense hormones. We support people through every chapter of their gender journey.
What We Must Understand as Pharmacists
So, what do these case studies teach us? Beyond the regimens and bloodwork, they point to a broader truth: gender-affirming care is not just medical. It’s relational, iterative, and deeply human.
Pharmacists must be prepared to:
Navigate formulation changes: Cost, shortages, or side effects can push patients to switch forms — from oral to patch to gel to implant. Each change needs sensitive, informed counselling.
Monitor with intention: Knowing when to test serum levels isn’t enough. Pharmacists should also know why it matters in the context of GAHT — and how to act on the results.
Support non-standard regimens: Patients may microdose, stop therapy, or use compounded options. Rather than gatekeep, pharmacists should assess safety, offer support, and respect autonomy.
Respond to distress: When a patient says “I’m not seeing the changes I expected,” it’s not time to quote averages — it’s time to listen, validate, and explore options together.
Advocate: From stocking medications to liaising with affirming prescribers, pharmacists can help remove barriers to care in practical, everyday ways.
Affirming Care Starts with Us
Many pharmacists want to be allies — but allyship without education can unintentionally cause harm. GAHT is not niche or experimental. It is evidence-based, life-saving healthcare, backed by clinical guidelines and decades of lived experience.
To support GAHT patients well, pharmacists must move beyond “do no harm” to “actively do good.” That means using correct pronouns, acknowledging goals without judgment, and seeing the patient not just as a set of hormones or pathology results — but as a person trusting you with one of the most vulnerable aspects of their life.
And here’s the thing: we’re already doing this. Every time a pharmacist explains how to rotate a patch site, reassures someone whose testosterone levels have dipped mid-cycle, or advocates for an emergency supply during a formulation shortage — we are practicing gender-affirming care. Now, we just need to do it consistently, confidently, and with a deeper understanding of the whole journey.
Final Thoughts
These case studies aren’t just narratives. They’re reminders that behind every Progynova tablet or Reandron vial is a person navigating a complex, courageous journey toward congruence.
As pharmacists, we have the knowledge, the access, and the trust of our communities. Let’s use it to ensure that gender-affirming hormone therapy is not just available — but affirming, informed, and equitable.