Transgender And Gender Diverse People Research Articles

Transgender Lived Experience in Social Work: A Critical Discourse Analysis

To date, social work literature regarding transgender and gender diverse (TGD) individuals situates TGD individuals as objects of social work knowledge and intervention. While this existent work represents an important foundation, it may foreclose other positionalities for TGD individuals. Therefore, this feminist critical discourse analysis of social work literature utilizes professionalization and transnormativity as conceptual anchors to explore the phenomenon of “transgender lived experience” in social work literature in order to understand both the nature of transgender lived experience and who is permitted to have it. Ultimately, this project found that transgender lived experience within social work is a totalizing discourse centered on a wholly painful experience of othering that can only be ameliorated through medical intervention. While this experience can confer expertise upon some individuals, transnormativity and professionalization operate in concert with this discourse to situate TGD people as transgender in the first place, foreclosing any other subjectivity. Therefore, future inquiry into the experiences of TGD individuals in social work must be willing to embrace epistemic perspectives and methodologies that emphasize the nuance and diversity of individuals’ experiences and resist totalizing grand narratives.

Sociodemographic profile, health-related behaviours and experiences of healthcare access in Italian transgender and gender diverse adult population.

Information on the general health of transgender and gender diverse (TGD) individuals continues to be lacking. To bridge this gap, the National Institute of Health in Italy together with the National Office against Racial Discriminations, clinical centres, and TGD organizations carried out a cross-sectional study to define the sociodemographic profile, health-related behaviours, and experiences of healthcare access in Italian TGD adult population. A national survey was conducted by Computer-Assisted Web Interviewing (CAWI) technique. Collected data were compared within the TGD subgroups and between TGD people and the Italian general population (IGP). TGD respondents were 959: 65% assigned female at birth (AFAB) and 35% assigned male at birth (AMAB). 91.8% and 8.2% were binary and non-binary TGD respondents, respectively. More than 20% of the TGD population reported to be unemployed with the highest rate detectable in AMAB and non-binary people. Cigarette smoking and binge drinking were higher in the TGD population compared with IGP (p < 0.05), affecting TGD subgroups differently. A significant lower percentage of AFAB TGD people reported having had screening for cervical and breast cancer in comparison with AFAB IGP (p < 0.0001, in both cases). Over 40% was the percentage of AFAB and non-binary TGD people accessing healthcare who felt discriminated against because of their gender identity. Our results are a first step towards a better understanding of the health needs of TGD people in Italy in order to plan the best policy choices for a more inclusive public health.

Medical schools as cisgendered organizations

Organizations and their practices contribute to the marginalization of transgender and gender diverse (TGD) populations by rewarding gender normativity and punishing gender transgression. The present study draws on data gleaned from four focus groups completed in 2023 with a total of 19 participants to explore TGD U.S. medical students’ perceptions of TGD content inclusion in their medical school curricula. Using abductive analysis, I argue that curricular oversights which omit socio-political contexts regarding TGD health and healthcare, as well as continued pathologization of TGD communities and people, contribute to a hostile learning environment for TGD medical students and residents. I conceptualize medical schools as cisgendered organizations where inequities devaluing TGD people and experiences are embedded in the organizational structure, including curriculum development and implementation. I provide recommendations for medical schools and stakeholders to align their formal, informal, and hidden curricula through practical means (e.g., incorporating TGD standardized patients throughout) and structural means (e.g. hiring and supporting TGD faculty across disciplines to assist with curriculum development and training), and argue for governing bodies to push back against legislative restriction and criminalization of TGD medical care.

Disparities in Study Inclusion and Screening Rates in Breast Cancer Screening Rates Among Transgender People: A Systematic Review

BackgroundBreast cancer screening trends of transgender and gender diverse (TGD) people remain largely unknown. This is concerning, as data are necessary to inform recommendations made by clinicians to their patients and by national guidelines to clinicians. The aim of this review is to explore the state of existing research literature and provide a summary report of current breast cancer screening rates in TGD adults. MethodsAll articles were identified using Medical Subject Headings terms. Inclusion criteria were all the following: (1) documents inclusion of at least one participant who identifies as a TGD person; (2) at least one TGD participant with top surgery or currently receiving estrogen-based gender-affirming hormone therapy; (3) results that report rates of breast cancer screening or mammogram referral. ResultsTwelve articles met inclusion criteria, six cross-sectional studies and six retrospective chart reviews. Three studies conducted secondary analysis of the Behavioral Risk Factor Surveillance System national dataset, and nine articles recruited their own sample with number of TGD participants ranging from 30 to 1,822 and number of cisgender women ranging from 242 to 18,275. Three studies found lower rates of screening in transfeminine persons receiving gender-affirming care compared with cisgender women; two studies found lower rates among TGD people compared with cisgender women; and three studies found no differences between the breast cancer screening rates of TGD and cisgender participants. ConclusionLimited studies recruit and report trends in breast cancer screening of TGD people. Those that do include TGD participants have mixed results, but overall TGD people had lower rates of breast cancer screening. More research is needed regarding breast cancer screening of TGD people to inform the development of protocols that ensure equitable access to preventative care.

Cancer Screening and Prevention in the Transgender and Gender Diverse Population: Considerations and Strategies for Advanced Practice Nurses

ObjectivesThis discussion paper presents recent evidence regarding cancer screening and prevention among the transgender and gender diverse (TGD) community and highlights where and how advanced practice nurses (APNs), particularly those in primary care, can better contribute to closing the gap between healthcare disparities between TGD and cisgendered populations. MethodsRelevant publications on the topic and professional guidelines and evidence have formed the basis for this discussion paper. ResultsTGD individuals are a vulnerable population with unique needs. They remain at risk of cancer and might be at greater risk of developing some cancers compared to cisgendered people but are underscreened. Barriers to gender-affirming care need to be addressed to improve access to prevention and screening services and improve the cancer care experiences and outcomes of TGD people. ConclusionAPNs can work in collaboration with TGD individuals and the healthcare system to improve access to culturally safe cancer screening and more effective prevention of cancer and poor cancer outcomes. Implications for Nursing PracticeAPNs have the potential to improve access to cancer screening for TGD people by increasing their understanding of the needs of the population, providing culturally safe care, and advocating for more preventative care and cancer screening. With greater knowledge and understanding of the needs and preferences of TGD people both broadly and in relation to cancer screening and prevention, targeted interventions and care approaches can be implemented. APNs should also aim to conduct evaluations and research into cancer prevention and screening to build the currently limited evidence base and nursing knowledge in this important field.

245 Drawing on Arts-Based Methodologies to Elicit Transgender and Gender Diverse (TGD) Children’s Experiences in Health Care

OBJECTIVES/GOALS: Understand how prepubescent TGD children experience pediatric care with a dual purpose of informing clinical practice and presenting alternative methods for research with children. Centering their perspectives is critical to improving care for this age group, ultimately improving TGD health. METHODS/STUDY POPULATION: A participatory arts-based study involving drawing, photo elicitation, and narrative interviews with prepubescent TGD children (n=15) in the Pacific Northwest. Participants will make photos and draw a picture of their most recent pediatric visit. Participants guide the analysis and interpretation of their artwork, informing subsequent interviews. Interviews are coded and interpreted using inductive thematic analysis at the semantic level, and verified by participants and near-peer community partners. The combination of multiple data sources that represent both stimuli and verifiers of perceptions provide methodological triangulation. RESULTS/ANTICIPATED RESULTS: Early pilot data with community partners suggest that TGD children do not feel sufficiently supported in pediatric settings, which impacts their sense of safety and agency in the clinical context. Findings will inform changes to clinical practice to improve gender affirmation for prepubescent children, positively impact child-caregiver relationships, and ultimately improve health care and wellbeing for TGD people. Observations related to the implementation of novel methodologies will inform future research practices intended to include younger children as active agents in the knowledge production process. DISCUSSION/SIGNIFICANCE: There are missed opportunities to positively impact children’s health and caregiver-child relationships when gender affirming care is overlooked in the pediatric context. This study provides first-hand multi-media perspectives to inform improvements in prepubescent gender affirming pediatric care.

Food Insecurity and Mental Health Outcomes Among Transgender and Gender-Diverse Communities in the United States Post-COVID-19

A growing body of literature has shown that people in the transgender and gender-diverse (TGD) community have worse health outcomes than cisgender (cis) people, including higher rates of poor mental health. Additionally, during COVID-19, TGD persons experienced higher rates of food insecurity. In this article, we extend the literature by looking at new data in the post-COVID-19 period, a period of greater stability. Using data from the U.S. Census Household Pulse Survey (HPS), we explore the relationship between gender identity and health outcomes. The HPS began collecting data on gender identity of participants from July 2021. We analyze responses from 1.2 million survey participants between July 2021 and May 2023. Using an ordinary least squares regression model with state and week fixed effects, we show that, on average, TGD people are seven percentage points more likely to report experiencing food insecurity compared with cis persons. TGD persons also report more symptoms of depression (six percentage points) and anxiety (four percentage points) than cis persons. These results hold after controlling for the socioeconomic, demographic, and sexual identity characteristics of the individuals, suggesting that this gender identity imposes an additional cost that cannot be explained by social determinants of health. We find that health insurance and the Supplemental Nutrition Assistance Program do not provide very much protection to TGD individuals. In summary, our article suggests the need for safety nets that target specific contextual and institutional challenges faced by TGD communities to reduce health disparities across the country.

Prevalence and Determinants of Cervicovaginal, Oral, and Anal Human Papillomavirus Infection in a Population of Transgender and Gender Diverse People Assigned Female at Birth.

Purpose: The human papillomavirus (HPV) causes cervicovaginal, oral, and anogenital cancer, and cervical cancer screening options include HPV testing of a clinician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face many barriers to preventive care, including cancer screening. Self-sampling options may increase access and participation in HPV testing and cancer screening. This study estimated the prevalence of HPV in self-collected cervicovaginal, oral, and anal samples from Midwestern TGD individuals AFAB. Methods: We recruited TGD individuals AFAB for an observational study, mailing them materials to self-collect cervicovaginal, oral, and anal samples at home. We tested samples for high-risk (HR; 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and other HPV genotypes (6, 11, 66, 68, 73, 90) using a polymerase chain reaction mass array test. Prevalence ratios for HPV infection at each site as a function of participant characteristics were estimated in log-binomial models. Results: Out of 137 consenting participants, 102 completed sample collection. Among those with valid tests, 8.8% (HR = 6.6%; HPV 16/18 = 3.3%) were positive for oral HPV, 30.5% (HR = 26.8%; HPV 16/18 = 9.7%) for cervicovaginal HPV, and 39.6% (HR = 33.3%; HPV 16/18 = 8.3%) for anal HPV. A larger fraction of oral (71.4%) than anal infections (50.0%) were concordant with a cervicovaginal infection of the same type. Conclusions: We detected HR cervicovaginal, oral, and anal HPV in TGD people AFAB. It is essential that we reduce barriers to cancer screening for TGD populations, such as through the development of a clinically approved self-screening HPV test.

The Role of Psychiatry for Transgender and Gender Diverse Adults.

Since the inclusion of gender identity disorder in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), psychiatry and the broader medical field have made substantial alterations in their recognition of and respect for transgender and gender diverse (TGD) identities. As this recognition continues to expand, psychiatrists should be aware of both historical harm and current best care practices, especially in light of psychiatric morbidity in TGD populations relative to the general population. This article contextualizes the history of psychiatry's engagement with TGD patients and presents the gender minority stress and resilience model to frame the mental health disparities experienced by TGD people. We envision a role for psychiatry that goes beyond gatekeeping gender-affirming hormone therapy and surgeries. Instead, we should invest in equitable care across the continuum of mental health needs. We provide an overview of existing literature to help characterize psychiatric epidemiology for this population, with the goal of offering guidance on how psychiatrists can deliver responsive and high-quality care for TGD people. Some key areas of proposed clinical improvement include culturally tailoring interventions for substance use disorders, reducing medical trauma in acute psychiatric care settings, and better understanding the interplay of psychopharmacology and gender-affirming hormone therapy.

Estimate and needs of the transgender adult population: the SPoT study.

Despite the increasing interest in transgender health research, to date little is known about the size of the transgender and gender diverse (TGD) population. A web-based questionnaire survey was developed, including a collection of socio-demographic characteristics and disseminated online through social media. Gender incongruence was evaluated by using a 2-item approach assessing gender recorded at birth and gender identity. The primary objective of the present population-based study was to estimate the proportion of TGD people across ages among a large sample of people who answered a web-based survey. The secondary endpoints were to identify gender-affirming needs and possible barriers to healthcare access. A total of 19,572 individuals participated in the survey, of whom 7.7% reported a gender identity different from the sex recorded at birth. A significantly higher proportion of TGD people was observed in the youngest group of participants compared with older ones. Among TGD people who participated in the study, 58.4% were nonbinary, and 49.1% experienced discrimination in accessing health care services. Nonbinary TGD participants reported both the need for legal name and gender change, along with hormonal and surgical interventions less frequently compared to binary persons. Being TGD is not a marginal condition In Italy. A large proportion of TGD persons may not need medical and surgical treatments. TGD people often experience barriers to healthcare access relating to gender identity.

Polish mental and sexual health specialists working with transgender and gender diverse persons - who are they and what is their background?

This study aimed to present the demographic and professional characteristics of Polish mental and sexual health specialists (MSHS) and their experience in clinical work with transgender and gender diverse (TGD) people. This cross-sectional study was conducted using the LimeSurvey platform. A total of 239 MSHS with a diverse professional background, at different stages of their careers, with experience of working with TGD patients, completed the survey. Participants were asked to provide demographic (e.g., gender and sexual identity) and professional (e.g., knowledge of leading standards and guidelines of care) data. Descriptive statistics were used. The mean age of participants was 39.5 years (SD 7.92) and the majority were assigned female at birth (73.2%). The sample was composed predominantly of psychotherapists (70%), then psychologists (53%), medical doctors (31%) and certified sexologists (5.9%). The majority (72%) practised in large cities (>500,000); 68.6% reported female gender identity, 24.7% a male identity and 6.3% were TGD; 63.2% were heterosexual, 12.1% homosexual, 12.6% bisexual, and 12.1% reported other sexual identity. Both the significance of religion and religious practice were significantly decreased compared to general Polish population. Most participants declared that they either do not know the basic guidelines of care for TGD people at all or know them very little. The majority of MSHS rated their professional training as insufficient. People providing clinical services to TGD patients are a professionally diverse group. There is an urgent need to expand and intensify professional training directed at MSHS on topics related to the health care dedicated to TGD people.

Unmet Needs, Minority Stress and Mental Health Outcomes Among Transgender Individuals: The Mediating Role of Schema Domains.

Exposure to gender-related minority stressors, the negative experiences and beliefs that stem from anti-trans stigma increases transgender and gender diverse (TGD) people's vulnerability to experiencing poor mental health outcomes. This study examined if the relationships between experiences of minority stress and mental health outcomes were mediated by early maladaptive schemas: mental representations shaping the way people view themselves, others and the world. Drawing from a schema therapy perspective, the study additionally examined if caregivers' failure to meet TGD people's core emotional needs was associated with mental health outcomes and if schemas similarly mediated these relationships. A total of 619 TGD adults completed an online survey about early maladaptive schemas, core emotional needs, gender-related minority stress and psychological distress and wellbeing. Causal mediation analyses indicated that caregivers who did not meet TGD people's core emotional needs and greater experiences of minority stress were associated with increased distress and lower wellbeing. These relationships were mediated by schema severity, particularly the disconnection and rejection and impaired autonomy domains. These findings provide empirical support for the schema therapy model's assumption that unmet core emotional needs are associated with schema formation. For TGD people, maladaptive beliefs about the self, others and world can form in response to manifestations of anti-trans stigma within the individual, their interpersonal relationships, community and broader society. Caregivers' failure to meet needs, plus experiences of minority stress throughout the individual's system, leads to greater distress and lower wellbeing; however, clinical interventions targeting schemas may improve outcomes for this at-risk group.

Health ICTs and transgender health equity: a research agenda

ABSTRACT While research in healthcare service provision for transgender and gender diverse (TGD) people has seen rapid progress, health information communication technologies (health ICTs) research on this key population is falling behind. Blindspots in the literature risk perpetuating systemic barriers to healthcare access. This critical, cross-disciplinary literature review applies a health equity perspective alongside the lenses of structural violence and intersectionality. It presents a research agenda for building systematic knowledge in the Information Systems (IS) and Information Communication Technologies for Development (ICT4D) fields, identifying and addressing blindspots that risk amplifying existing inequities for TGD people. It makes theoretical contributions to discourse on health equity and ICTs by exploring how health ICTs shape the inclusion and exclusion of marginalized communities. In facilitating a scholarly and practice-based understanding of the effect of health ICTs on TGD health provision, it paves the way for these fields to make significant contributions to global health equity.

Transgender and gender diverse individuals' perspectives on discussions of fetal sex chromosomes in obstetrics care.

In the past decade, prenatal cell-free DNA screening (cfDNA) has become ubiquitous as a screening tool for fetal aneuploidy and sex chromosomes. Healthcare provider (HCP) discussions and public perceptions of sex and gender uniquely impact transgender and gender diverse (TGD) individuals, and existing cfDNA guidelines lack recommendations regarding how to discuss sex and gender prenatally. The aim of this exploratory qualitative study was to examine TGD individuals' opinions regarding fetal sex chromosome disclosure sessions. Twelve semi-structured virtual interviews were conducted with TGD individuals regarding their perspectives on the discussion of fetal sex chromosomes by HCPs within the prenatal setting. Interviews were coded and analyzed using a reflexive thematic approach, generating four major themes: (1) Current practices in prenatal care exclude gender diverse people; (2) HCPs' responsibility to de-gender discussions of sex chromosomes in prenatal care; (3) HCPs' responsibility to acknowledge gender diversity; and (4) HCPs' influence on societal perceptions of sex and gender. More guidance is needed from professional societies regarding best practices for HCP discussions of sex chromosomes, sex, and gender. Participants recommended HCPseducate patients about sex chromosomes and their relevance to health while avoiding the conflation of sex and gender terms. Additionally, there is an acute need for trans-inclusive prenatal healthcare. Ultimately, HCPs' and organizations are in a prime position to deconstruct rigid gender binaries and promote societal inclusion of TGD people.

Gender minority stress and diurnal cortisol profiles among transgender and gender diverse people in the United States

The field of behavioral neuroendocrinology has only begun to explore the lived experiences of transgender and gender diverse (TGD) people exposed to stigma. In light of escalating attacks and legislation targeting TGD people in the United States, it is crucial to examine the physiological pathways through which gender minority stressors become embodied, impact health, and contribute to health inequities. The Trans Resilience and Health Study included baseline data collection from fall 2019 to spring 2020 from a sample of 124 TGD people, reflecting a diversity of gender identities (e.g., trans masculine, trans feminine, and nonbinary) and ages (range = 19–70 years old; M = 34.10), living in Michigan, Nebraska, Oregon, and Tennessee. These analyses examine experiences of gender-related enacted stigma in association with hypothalamic-pituitary-adrenal (HPA)-axis functioning. Among those experiencing the highest levels of enacted stigma, findings show a blunted cortisol awakening response and sluggish daily decline that resulted in elevated concentrations at bedtime compared to those experiencing less enacted stigma. These results of flattened diurnal activity are consistent with an emergent literature on discrimination as a social determinant of potential stress pathophysiology. In contrast, community connectedness was associated with a larger, more dynamic cortisol awakening response. These findings emphasize the importance of incorporating gender-minority stress and resilience measures when studying HPA-axis functioning among TGD people.

School of social welfare transgender justice group: student-led advocacy to promote justice and equity for gender diverse college students

Transgender and gender diverse (TGD) social work students experience microaggressions on campuses, curricula that are often cissexist and stigmatizing, and a lack of inclusive facilities, like gender-neutral bathrooms. The Transgender Justice Group (TJG) was founded by students at a School of Social Welfare (SSW) to respond to these and other pressing issues on the campus of a public university in the Midwestern U.S. This report aims to describe the formation process and activities of the TJG and provide recommendations for students, staff, and faculty who are interested in creating similar groups at other universities. Students and supporting faculty used a nonhierarchical approach to define, strategize, and implement advocacy goals, including creating more trans-affirming classrooms and increasing positive and proactive administrative responses to recent harmful anti-trans laws. Strategies for achieving these goals included engagement with a private, student-only online group chat, the production of regular informational webinars, and student-led meetings with school administrators to formally address state political actions negatively affecting TGD and queer people. Our group benefited from a dual focus on student support and advocacy. Through the TJG’s ongoing work, students learned to collaborate more effectively, a skill that is crucial for their careers in the social work profession.

Evaluation of a transgender health training program for pharmacists and pharmacy students in Australia: A pre-post study

BackgroundDisparities in healthcare for transgender and gender diverse (TGD) people are well-recognized, with pharmacists reporting a lack of knowledge impacting confidence in their interactions with TGD people. Therefore, a training program in TGD healthcare was designed to address this knowledge gap. ObjectiveTo evaluate the impact of the TGD healthcare training program on the awareness, knowledge, and behaviour of pharmacists and pharmacy students in Australia. MethodAn online training program was evaluated by pre-and post-test surveys, which assessed the knowledge and awareness of participants, and three-month post-training interviews, which examined the effect of training on pharmacists' practice when providing care to TGD people. Data were analyzed using paired t-tests, content and thematic analysis. ResultFifty-six pharmacists and twenty-one pharmacy students completed the training and pre-and post-test surveys. Ten pharmacists were interviewed post-training. There was a significant improvement in the awareness (pharmacists, p ≤0.001; students, p = 0.006), knowledge (pharmacists and students, p ≤0.001) and total (pharmacists and students, p ≤0.001) post-test scores for both groups. Interviewed participants found the training program comprehensive and relevant to their practice. ConclusionThis study has demonstrated that educational interventions improve TGD healthcare awareness and knowledge for pharmacists and students with the potential to improve healthcare provision to TGD people and promote inclusivity in society.

Strategies for Providing Gender-Affirming Care for Adolescents in the Primary Care Setting.

Transgender and gender diverse (TGD) youth have high rates of health disparities and face significant barriers to accessing medical care. Primary care providers (PCPs) are often the first health care providers that TGD youth seek out to discuss gender identity and find support. Thus, it is crucial for PCPs to have an understanding of gender diversity and knowledge to support TGD youth with gender-affirming care. The purpose of this article is to offer strategies PCPs can implement to increase their comfort and capacity in providing care for TGD people. Key steps to support TGD youth in the primary care setting include creating affirming clinical environments, discussing gender identity at routine visits, supporting parents and families, supporting social transition, and providing menstrual suppression for those who desire it. Multidisciplinary gender clinics can partner with PCPs to support adolescents in accessing gender-affirming medical care and to provide additional education and support. [Pediatr Ann. 2023;52(12):e442-e449.].

Perioperative Care of Transgender and Gender-Diverse Patients: A Biopsychosocial Approach

(Anesth Analg. 2023;137:234–246) Health care disparities exist across populations, and one group that has come to the forefront in recent years is transgender and gender diverse (TGD) individuals. In general, TGD people have less access to health care and fewer individuals in this population seek care due to systemic inequity. These disparities lead to greater disease burden, a greater likelihood of missed care for a chronic health condition, and other worrisome outcomes. TGD individuals are increasingly seeking gender-affirming care (GAC), and this often involves anesthesiology professionals participation in gender-affirming surgery (GAS). This article describes a biopsychosocial approach to GAC that offers holistic care for TGD individuals from anesthetic professionals in particular.

Do the attitudes and practices of Australian pharmacists reflect a need for education and training to provide care for people who are transgender?

Many transgender and gender diverse (TGD) people access care through community pharmacy in Australia. However, there is limited information available about the role of Australian pharmacists in providing care for TGD people. To explore the attitudes, practices, and training needs of pharmacists in the provision of care for TGD people in Australia. Pharmacists Australia-wide were invited to participate in an online survey through Facebook, e-newsletters of pharmacy organizations and a professional pharmacy journal. Quantitative data were analysed for descriptive and inferential statistics. A Fisher exact test was used to investigate associations between two variables. Results with P value <0.05 were considered statistically significant. Content analysis was used to analyse data from free-text responses. Of the 169 respondents, the majority were female (75.1%), aged below 40 years (74%) and with less than 10 years of working experience as a pharmacist (58%). Although 95% of the sample agreed that they had an important role in the provision of care for TGD people, only 29.6% were confident about their knowledge of pharmacotherapeutic treatments for gender affirmation. Only 2.4% had received education about TGD care at university, and only 5.3% received any TGD healthcare training over the past 5 years. Although pharmacists had a positive attitude and recognized their role in TGD care, they expressed a lack of confidence in their knowledge to be a barrier to providing quality care. Most recommended the need for more education about TGD healthcare in pharmacy curricula and continuous professional education activities.