Gender Care and Love Course Empowers Future Pharmacists With Empathy

In his journey toward coming out as trans, Alexander Gilmer, PharmD, faced a number of challenges, including navigating his own health care.

He was turned away by pharmacies and providers. He had to fight for appropriate labs and monitoring, and he was put through unnecessary invasive procedures. The experience inspired Gilmer to discover his passion for educating people.

Through a pioneering course called Gender Care and Love, Gilmer, a clinical inpatient pharmacist at UCSF Medical Center at Mission Bay, is equipping second-year PharmD students with the skills and understanding needed to provide compassionate and competent care to transgender and nonbinary patients.

“Our job isn’t simply to start counseling but to build trust,” Gilmer said, instructing the class to recognize that gender identity and history cannot be assumed by outward appearance. “I’ve had to educate every single one of my providers.”

Health equity and cultural humility

The course is part of the school’s foundations series, which is intended to build a strong baseline of knowledge before learners dive into the details of disease conditions and approaches to therapeutic treatment. The series also reflects the school’s commitment to inclusivity and health equity, preparing future pharmacy leaders to become change agents by enhancing the care of underserved groups.

The course develops new levels of sensitivity even in classrooms where students already have general awareness of the directive to be culturally humble when providing care to marginalized populations.

“What I loved most about Dr. Gilmer’s lecture was how raw and real it was. Any time someone is able to be vulnerable with us, it becomes a much more profound learning experience,” said Eilee Mendoza, a PharmD student in the Class of 2026. “I really appreciated Dr. Gilmer’s willingness to share such a personal part of his journey. As health care providers, it’s our responsibility to take the extra step to deeply understand the needs of gender-affirming care.”

To introduce the curriculum, which integrates discussions about gender, gender incongruence, gender dysphoria and transition, Gilmer offered perspective through statistics: Nearly half of transgender adults – some 1.3 million people, according to Gilmer’s presentation – faced negative health care experiences in 2020, and 30% said that none of their providers even know they are trans.

A medical provider lacking this vital information is potentially dangerous in any number of scenarios that Gilmer described to the class, such as knowing whether a patient has a uterus and could be pregnant before prescribing medication.

Addressing empathy and disparity

Gilmer has been teaching versions of the course since 2016. Following his residency, he was encouraged by the pharmacy director at the hospital where he worked to join a health equity group. He began by sharing statistics that were closely related to his own story.

“The curriculum has evolved as I’ve decided what statistics are important to both welcome people and open the dialog – and to ask people to come in with an empathetic viewpoint,” he said.

A lack of empathy is often the root of health care issues among trans patients, Gilmer added, which is why his course includes research from his zoology background showing that the gender nonbinary exists across the animal kingdom. The course also includes anti-racist and cross-cultural perspectives on gender fluidity.

Competency and sensitivity

The course sheds light on current societal debates, as well as on systemic issues that prevent trans patients from getting culturally competent care, such as discrepancies between lived names and legal or administrative names in medical records.

One tactic Gilmer recommends as a way to sensitively conduct patient inquiry and ascertain accurate gender identity information is for the provider to always offer their own pronouns first upon introduction. Another is to never ask about surgeries a patient has or has not had, unless doing so is necessary to their current visit or to update their chart.

In general, Gilmer advocates for coordinating care with the patient’s insight and input, reminding learners of a classic pharmacist motto: the best medication for any patient is the one they’ll actually take.

Exposure and impact

Gilmer said that in addition to opening a dialog in the pharmacy community, his course has opened minds in unexpected ways and in unexpected places. He describes an interaction with a pharmacy technician he worked with in North Carolina who at first questioned the course material, but ultimately became an outspoken advocate for the trans community in the hospital’s emergency department.

“Approaching all care with a trauma-informed lens is essential,” Gilmer said, adding that in terms of patient outcomes, “having someone on your side can make all the difference, and can be rewarding for the patient and for the pharmacist.”