Accessing and navigating gender‐affirming hormone therapy and perspectives on inclusive pharmacy care among transgender and gender diverse people: a qualitative study

Introduction

Transgender and gender diverse (TGD) people continue to experience inequities in access to gender-affirming care, including stigmatisation, delayed treatment and non-inclusive healthcare encounters. Community pharmacies may represent an accessible setting to support inclusive and affirming care; however, lived experiences of engaging with community pharmacy services in the context of gender-affirming hormone therapy (GAHT) remain underexplored, particularly among younger people who represent the greatest proportion of the TGD community. This study aimed to explore the lived experiences of accessing, navigating and receiving GAHT, alongside participants' perspectives on barriers and facilitators to accessing inclusive and affirming care within community pharmacy.

Methods

Semi-structured interviews were conducted between October and November 2025. Interviews explored participant experiences of accessing GAHT and perspectives on inclusive and affirming pharmacy practice. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. NVivo (Version 15) facilitated data management, and the COREQ and CCRF checklists informed reporting. Ethical approval was obtained from the Newcastle University Research Ethics Committee (reference: 66105/2023).

Results

Ten participants, representing a range of gender identities, were interviewed. Three overarching themes were developed: (1) reflecting on the challenges of navigating gender-affirming hormone therapy; (2) exploring the impact of healthcare barriers upon an individual and (3) accessing and receiving inclusive and affirming pharmacy care. Participants viewed community pharmacies as accessible and supportive environments for affirming care when underpinned by respectful communication, visible inclusivity, appropriate staff training and partnership working with TGD communities.

Conclusion

In this study, TGD individuals described significant structural and interpersonal barriers when accessing GAHT in the United Kingdom, negatively influencing trust, wellbeing and engagement with healthcare services. Community pharmacies may represent an underutilised, yet important, setting for inclusive and gender-affirming support. Embedding gender-affirming training and co-designed approaches within pharmacy services may strengthen accessibility, trust and equity in care for TGD communities.

Lived Experience or Public Contribution

A person with lived experience from the TGD community (ID) acted as a co-author and patient champion in this study; they supported the design and conduct of the research, advised on inclusive and non-stigmatising approaches and supported preparation of the manuscript, contributing a lived-experience perspective throughout.