Drop off your CV/Resume
We'd love to hear from you. Send us your CV/Resume and one of our team will be in touch.
Let’s begin with the basics: the difference between sex and gender. Sex considers the...
Let’s begin with the
basics: the difference between sex and gender. Sex considers the biological
makeup we’re assigned at birth. Gender refers to socially constructed roles,
identities, behaviors, and expressions. Our personal identity is based on our
internal awareness, and those who feel that their gender is different from
their sex are considered transgender (or trans).
Nowadays, there’s
rightly much more visibility and conversation surrounding transgenderism, but
this hasn’t stemmed from anywhere. In fact, identities beyond the ‘traditional’
Western understanding have been noted and celebrated across various cultures
around the world throughout history.
Still, although
people are now better able to characterize their feelings of gender
incongruence, the trans community sadly continues to face discrimination,
violence, and poverty. Social factors like the aforementioned can have huge
implications on the health of trans individuals, both psychologically and
physically. Did you know that 82% of the trans
community has
considered suicide, and 40% attempted it?
But that’s not all.
No, when looking at healthcare at large, a 2021
survey found that
almost half of the respondents felt pharmaceutical companies could do more to
understand and engage with members of the queer community, particularly those
who identify as lesbian, transgender, or non-binary.
Today, we’re going
to look at the healthcare challenges trans people face and how the
pharmaceutical industry can better support the community and address health
inequity.
A 2018
report by Stonewall found
that 62% of the trans community had experienced a lack of understanding from
healthcare professionals (HCPs) in specific trans needs. Likewise, another study found that only 69% of physicians felt they were capable of providing routine care for transgender patients. Not only does this mean
trans people are subject to experiencing poorer health outcomes, it also means
that because of these experiences, trans people are also less likely to seek
care.
For the most part,
HCPs lack confidence in their decision-making for trans patients because of the
uncertainty surrounding the influence therapies can have on hormone treatments.
This only highlights the sheer lack of research into hormonal differences in
trans people versus cis.
Just think about it…
dosages are routinely tweaked throughout pregnancies due to hormonal
differences, yet the same adjustments aren’t made for those in the trans
community, despite the fact that there’s a similar need for tailored dosages
due to hormonal changes.
Speaking of dosages,
even those who identify as trans but are yet to undergo their medical
transition must also be considered. That’s because, without hormone therapies
and surgeries, our assigned sex at birth can also influence what dosage we
should receive due to the amount of water in the body and the number of
drug-binding sites that person holds.
While HCPs lack the
knowledge to confidently prescribe treatments to trans patients, the data gap
largely comes down to the exclusion of the transgender community in clinical
trials. For most, the reason is that hormone treatments can potentially
complicate the interpretation of clinical trial data.
On top of that,
trans-specific research is, unfortunately, minimal. You might be wondering why.
Well, for most
pharmaceutical companies, there’s no business incentive to invest in hormone
therapies because they tend to be both off-patent and prescribed off-label.
That means that for companies to research these products independently, the
investment needs for researching and developing new treatments far outweigh the
profitability of developing new drugs because they can no longer be patented.
While it could take
some mighty convincing to get pharmaceutical companies to research trans
therapies, there is an enormous opportunity to investigate how hormone
therapies influence the effects and safety of other prescribed treatments for
needs that are disconnected from transitioning.
For example, an NYU
study on cancer found
that 80% of oncologists admit they don’t feel they know enough about treating
the trans community, and a respondent from a Transgender
OUT Cancer survey commented, “my oncologist really wanted me to stop T [testosterone] during
treatment. I didn’t want to, so I didn’t, and everything was okay. I think he
didn’t know how it would affect the treatment, and every time I saw him, he
asked if I was willing to stop T.”
It’s worth noting
here that hormone therapies have significant psychological benefits for
transgender people. Being taken off their hormone therapies can be profoundly
distressing and even dangerous as they can increase the risk of violent attacks
for no longer ‘passing’ as their identified gender.
On top of that,
stopping the use of hormones can have even more detrimental effects, increasing
the risk of suicide. For this reason, it is absolutely essential that the
industry researches and understands the interplay between hormone therapies and
other treatments.
Another valuable
initiative (with a business incentive for pharmas) would be to investigate
clinical trial data on drug combinations for illnesses that disproportionately
affect the trans population, for example, HIV.
Sadly, transgender
women are 66
times more likely to
contract HIV, and transgender men seven times more likely. That’s a remarkably
high risk, which comes down to factors such as limited work opportunities due
to discrimination, increased susceptibility to bleeding and infection in the
genital region following gender reassignment surgery, and barriers in accessing
HIV preventative care such as PrEP.
In fact, even for
those who are able to access PrEP, adherence and compliance can be compromised
due to vagueness and fears of how PrEP could interfere with their hormones and
impact their hormonal transition. Not only is this information vital for trans
patients, but for HCPs too, so they can deliver accurate information on the
efficiency and safety of using PrEP in combination with hormones.
Incorporating
trans-focused research into clinical trials for new therapies could completely
transform how HCPs prescribe treatments. But not only that, focusing on the
LGBTQIA+ community would help ensure that trans patients are not put at a
greater risk than their cisgender counterparts when treated with modern
medicines.
Overall, evaluating
potential treatments in the context of sub-populations will only create more
patient-centric drug developments. For example, research results examining the
effects of treatments in conjunction with hormones for the trans community
could be adapted to other sub-populations, such as those who take hormone
replacement/blocking therapy to alleviate the effects of menopause or hormonal
imbalances.
Currently, as
mentioned above, clinical trials are not set up to cater to those who are
trans. However, to ensure that everybody receives fair access to innovative
therapies and to explore the treatments in the context of sub-populations,
trial recruitment and design need to be revitalized in order to be seen as an
attractive and worthwhile endeavor to the LGBTQIA+ community.
This begins with
linguistic adaptations that are inclusive of trans, non-binary, and intersex
individuals, particularly for conditions that are associated with a single sex.
For example, ovarian cancer traditionally falls under the bracket of ‘women’s
health,’ but a trans man legally registered as male can still live with the
disease.
Say a trial was to
be conducted for an ovarian cancer drug; the recruitment would typically ask
for women only to apply, rather than ‘people born with ovaries’. The effects of
these linguistic choices marginalize trans men, meaning that even though they
might be in dire need of that treatment, they wouldn’t apply.
Looking further into
the clinical trial process, paperwork must also be amended to ensure that
nuances are accounted for, accommodating everyone’s needs.
That means including gender and sex, including preferred name and legal
name, both of which are crucial distinctions for trans people. In short,
questions that might seem basic and obvious to a cisgender person can be much
more complex for someone who is trans.
On the whole, a
simple code switch to be more inclusive is more beneficial than you might first
think. Ultimately, by avoiding trans-exclusionary gendered language, confusion,
indecision, and other discomforts trans people often face – including from the
most well-meaning HCPs – can be alleviated.
Looking beyond
language, clinical trial environments and teams must also adapt to be more
inclusive, safe, warm and welcoming to those from the LGBTQIA+ community. That
means reflecting diversity throughout the environment, such as removing binary
categorization when it’s unnecessary and providing all staff interacting with
those patients with sensitivity training.
Luckily, there’s
someone leading the way: CRO, Parexel. Parexel’s Associate Director, Liam Paschall, is a trans man, and the CRO has leveraged Liam’s
internal lived-in experience, collaborated with the trans community, and held
patient advisory meetings. In light of doing so, they’ve been able to provide
recommendations on how the pharmaceutical industry can build trust with the
trans community, from using preferred pronouns to providing and promoting
inclusion and respect.
Furthermore,
pharmaceutical companies should actively pursue more diverse trial
investigators and patient advocacy liaisons. Simply put, if patients can relate
to industry insiders on their marginalized quality, trust in them and the
research is more likely to increase, leading to more recruitment and fewer
dropouts.
I’m sure you’d agree
that it’s only fair that all HCPs are equipped with the necessary understanding
to treat LGBTQIA+ patients with respect, dignity, and the confidence to make
informed decisions upon their care.
In order for that to
happen, there’s undoubtedly more work to be done regarding the inclusion of
queer patients in clinical trials and understanding the impact of hormones on
other treatments for the trans community. For this reason, we should actively
engage with queer communities to understand how to best meet their needs in the
world of research. That’s because unless these voices are purposefully sought,
there’s a high chance they’ll be overshadowed by those from non-queer groups.
To conclude, pledging and prioritizing inclusivity throughout the entire healthcare system will only nurture more trusting relationships between HCPs and LGBTQIA+ patients. In turn, this will lead to better and fairer health outcomes, which, after all, is a basic human right.
If you work in Pharma and are hoping to diversify your team to develop novel new therapies, reach out to us! We're connected with the best Life Sciences talent across the globe!