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Pharmacology · chapter 37 · Transgender and Nonbinary Drugs

Overview of Transgender and Nonbinary Health

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Past trauma can keep clients away

    Often, gender nonconforming individuals do not experience health care access in an accepting, nonthreatening, affirming, and supportive climate. In fact, some individuals have been so traumatized by their experiences that they forgo important medical care and preventive services.

  2. Self-assessment of personal bias

    Additionally, a self-assessment concerning personal bias and beliefs about transgender and nonbinary individuals is necessary for any health care professional who interacts with these particular clients.

  3. The first step toward acceptance

    Understanding one’s own beliefs and feelings, and acknowledging any bias or prejudice, is the first step in a nurse’s acceptance of transgender and nonbinary individuals’ decisions.

  4. Gender identity versus sex at birth

    A person’s gender identity is not always the same as the sex assigned at birth and is not always related to an individual’s sexual organs or sex characteristics.

  5. Clarify the client's own terms

    Individual clients will have their own terms to describe themselves, and the nurse must clarify those with each client.

  6. Transgender clients and treatment choices

    Some transgender individuals choose to have medical treatment to physically transition into the gender with which they identify; others choose not to undergo treatment.

  7. Gender dysphoria as a diagnosis

    Gender dysphoria is a medical diagnosis that describes the condition of an individual who is experiencing social and mental distress because of gender identity issues. The feelings may range from unease to severe distress and can impair the individual’s ability to function in society.

  8. Dysphoria often starts early

    Among their study participants, the earliest memories of gender dysphoria generally began around 4 1/2 years of age, with the majority of participants experiencing gender dysphoria memories by age 7.

  9. Not every transgender person has dysphoria

    Gender dysphoria does not occur in every transgender individual, nor is every person who experiences gender dysphoria transgender (National Center for Transgender Equality, 2016).

  10. Manifestations of gender dysphoria

    For those who do experience gender dysphoria, typical manifestations include depression, anger, anxiety, body aversion, posttraumatic stress disorder, hopelessness, violence, self-harm, and suicide.

  11. Intersex is not the same as transgender

    Intersex people and transgender people are not the same (and they are not interchangeable terms); many transgender people have no intersex traits, and many intersex people do not consider themselves transgender.

  12. Unnecessary infant surgery is rejected

    Most in the nursing, medical, and intersex community reject unnecessary surgeries intended to make a baby conform to a specific gender assignment (Behrens, 2020).

  13. Factors that affect drug therapy

    Drug therapy of any kind is affected by several factors, including gender at birth, transgender status, weight, and overall health.

  14. Assess and communicate dosing factors

    Thus, the nurse must ensure that any transgender client has been properly assessed for these factors and communicate this information to the health care provider, pharmacist, and other health care professionals as needed.

Terms to know

Gender identity
Gender identity describes a person’s deeply held beliefs about which, if any, gender they identify with—man, woman, gender fluid, or nonbinary.
Gender expression
Gender expression refers to ways in which a person outwardly expresses their gender identity.
Gender fluid
Gender fluid refers to a person who does not identify with a single fixed gender or has an unfixed gender identity.
Nonbinary
Nonbinary is used to describe individuals whose gender identity does not fit into the man–woman dichotomy and who do not identify with one gender over another.
Transgender
Transgender is a broad term used by individuals whose sex assigned at birth does not match their gender identity.
Cisgender
Cisgender describes individuals whose sex assigned at birth and gender identity are congruent.
Intersex
Intersex is a general term used to describe people whose sex traits, reproductive anatomy, hormones, or chromosomes are different from the usual two ways human bodies develop.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A nurse is about to start caring for transgender and nonbinary clients in a new clinic. According to the section, what is the first step in the nurse's acceptance of these clients' decisions?

    1. Understanding and acknowledging the nurse's own beliefs, feelings and any bias
    2. Referring every client to a specialty clinic
    3. Reviewing the clients' hormone doses
    4. Deciding which terms are correct for each client

    Answer: Understanding and acknowledging the nurse's own beliefs, feelings and any bias

    The section states that understanding one's own beliefs and feelings, and acknowledging bias or prejudice, is the first step in accepting these clients' decisions. Terms are clarified with each client rather than chosen by the nurse, and dose review or referral are not described as the first step.

  2. During admission, a nonbinary client describes their identity with a term the nurse does not know. What should the nurse do?

    1. Avoid discussing identity during the admission.
    2. Use the term listed in the chart instead.
    3. Clarify the term with the client.
    4. Choose the closest term from the textbook list.

    Answer: Clarify the term with the client.

    Clients have their own terms for themselves, and the nurse must clarify those with each client; some terms can be offensive and would compromise trust. Substituting another term or avoiding the topic does not respect the client's own description.

  3. A nurse is assessing an adolescent with gender dysphoria. Which manifestations are typical of gender dysphoria? Select all that apply.

    1. Body aversion
    2. Depression
    3. Hyperkalemia
    4. Anxiety
    5. Self-harm

    Answer: Body aversion, Depression, Anxiety, Self-harm

    Typical manifestations of gender dysphoria include depression, anger, anxiety, body aversion, PTSD, hopelessness, violence, self-harm and suicide. Hyperkalemia is an electrolyte problem, not a manifestation of gender dysphoria.

  4. A nursing student says, "All transgender people have gender dysphoria." How should the nurse educator respond?

    1. "That is correct; it is part of the definition of transgender."
    2. "Gender dysphoria only occurs in intersex people."
    3. "Gender dysphoria does not occur in every transgender person, and not everyone with it is transgender."
    4. "Gender dysphoria only begins in late adulthood."

    Answer: "Gender dysphoria does not occur in every transgender person, and not everyone with it is transgender."

    The section states gender dysphoria does not occur in every transgender individual, nor is every person with gender dysphoria transgender. Intersex and transgender are different, and dysphoria memories often begin early in childhood.

  5. A parent asks whether their intersex child is transgender. Which statement by the nurse is accurate?

    1. "Intersex and transgender are not the same, and the terms are not interchangeable."
    2. "Intersex and transgender mean the same thing."
    3. "Intersex traits are always recognized at birth."
    4. "All intersex people become transgender adults."

    Answer: "Intersex and transgender are not the same, and the terms are not interchangeable."

    Intersex and transgender people are not the same; many transgender people have no intersex traits and many intersex people do not consider themselves transgender. Some intersex traits are not recognizable until puberty or later.

  6. A transgender client is starting a new medication. Which factors does the section say affect drug therapy and should be assessed and communicated to the team? Select all that apply.

    1. Weight
    2. Gender at birth
    3. Overall health
    4. Transgender status
    5. The client's preferred pharmacy

    Answer: Weight, Gender at birth, Overall health, Transgender status

    Drug therapy is affected by gender at birth, transgender status, weight and overall health, and the nurse must assess these and share them with the provider and pharmacist. The choice of pharmacy is not a pharmacokinetic factor.

Where every quote comes from

Section 37.1 Overview of Transgender and Nonbinary Health of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.