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Letter to Pharmacies in Sweden Which Refuse to Accept Prescriptions for Gender Affirming Medical Treatment

Contents

To Whom It May Concern,

[member name, date of birth, and address]

We are writing to advocate for the above named person, who is receiving gender affirming healthcare with the advice of our service.

We were disappointed to hear that you are refusing to fulfil the prescription for the above named person’s gender affirming medical treatment. It is our judgement that this refusal to fulfil the person’s prescription is violating the person’s right to healthcare and placing the person at risk of harm.

Trans people comprise a vulnerable group in society who are systematically disadvantaged by prejudice, discrimination, and threats to their basic rights. Due to these challenges, trans people suffer significantly worse outcomes regarding mental health and social wellbeing than their cisgender peers. Access to gender affirming healthcare is a crucial part of alleviating these health disparities and enabling trans people to flourish.

The provision of gender affirming healthcare is supported by international professional organisations such as the World Professional Association for Transgender Health, the Endocrine Society, and University of California San Francisco, whose evidence-based guidelines are based on robust peer-reviewed research [1–3]. Such research has shown that gender affirming healthcare can be lifesaving and that it results in significant improvements in the mental health and social wellbeing of transgender youth. Moreover, the withholding of gender affirming healthcare has been shown to cause very serious harms, including increased risks of depression, anxiety, and suicide [4–14].

Gender is an aspect of one’s identity that falls within the sphere of one’s autonomy and right to self-determination [15–17]. The provision of gender affirming healthcare respects the rights of people to attain their embodiment goals and determine their own futures.

There is a clear indication for the above named person to access gender affirming healthcare. The above named person has a confirmed diagnosis of Gender Incongruence according to the criteria set by the 11th revision of the International Classification of Diseases. Not only is such treatment likely to be beneficial for the person’s health and wellbeing, but withholding such treatment would very likely result in serious deterioration of the person’s psychological health. Furthermore, the above named person has demonstrated the relevant understanding and capacity to give informed consent to the treatment, and so opposing this informed decision would amount to a violation of the person’s autonomy.

Our prescriptions comply with all the necessary regulations for medicinal products, including The Human Medicines Regulation 2012 [18]. Furthermore, the latest guidelines from the Swedish Medical Products Agency states that paper prescriptions issued within the European Union and European Economic Area should be accepted by pharmacies in Sweden [19].

By obstructing the above named person’s access to legitimately prescribed gender affirming medical treatment, it is our view that you are failing to act in the welfare of the person, are putting the person at risk of harm, and are violating the person’s right to healthcare. We therefore urge you to reconsider fulfilling the person’s prescription for treatment that is crucial for the person’s health.

Yours sincerely

GenderGP

References

International guidelines for gender affirming healthcare

  1. Centre of Excellence for Transgender Health (2016). Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people, 2nd edition, edited by Deutsch, M. B. University of California San Francisco.
  2. Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., and T’Sjoen, G. G. (2017). “Endocrine treatment of gender-dysphoric/gender-incongruent persons: An endocrine society clinical practice guideline”. Journal of Clinical Endocrinology and Metabolism, 102: 3869–3903.
  3. World Professional Association for Transgender Health (2022a). “Standards of care for the health of transgender and gender diverse people, version 8”. International Journal of Transgender Health, 23: S1–S259.

Research studies on gender affirming healthcare in transgender adolescents

  1. Allen, L. R., Watson, L. B., Egan, A. M., and Moser, C. N. (2019). “Well-being and suicidality among transgender youth after gender-affirming hormones”. Clinical Practice in Pediatric Psychology, 7: 302–311.
  2. Bungener, S. L., de Vries, A. L. C., Popma, A., and Steensma, T. D. (2020). “Sexual experiences of young transgender persons during and after gender-affirmative treatment”. Pediatrics, 146: e20191411.
  3. de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., and Cohen-Kettenis, P. T. (2014). “Young adult psychological outcome after puberty suppression and gender reassignment”. Pediatrics, 134: 696–704.
  4. Chen, D., Berona, J., Chan, Y. M., Ehrensaft, D., Garofalo, R., Hidalgo, M. A., Rosenthal, S. M., Tishelman, A. C., and Olson-Kennedy, J. (2023). “Psychosocial functioning in transgender youth after 2 Years of hormones”. New England Journal of Medicine, 388: 240–250.
  5. Grannis, C., Leibowitz, S. F., Gahn, S., Nahata, L., Morningstar, M., Mattson, W. I., Chen, D., Strang, J. F., and Nelson, E. E. (2021). “Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys”. Psychoneuroendocrinology, 132: e105358.
  6. Green, A. E., DeChants, J. P., Price, M. N., and Davis, C. K. (2022). “Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth”. Journal of Adolescent Health, 70: 643–649.
  7. Kuper, L. E., Stewart, S., Preston, S., Lau, M., and Lopez, X. (2020). “Body dissatisfaction and mental health outcomes of youth on gender affirming hormone therapy”. Pediatrics, 145: e20193006.
  8. Rew, L., Young, C. C., Monge, M., and Bogucka, R. (2021). “Review: Puberty blockers for transgender and gender diverse youth—A critical review of the literature”. Child and Adolescent Mental Health, 26: 3–14.
  9. Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., and Ahrens, K. (2022). “Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care”. JAMA Network Open, 5: e220978.
  10. Turban, J. L., King, D., Carswell, J. M., and Keuroghlian, A. S. (2020). “Pubertal suppression for transgender youth and risk of suicidal ideation”. Pediatrics, 145: e20191725.
  11. van der Miesen, A., Steensma, T. D., de Vries, A., Bos, H., and Popma, A. (2020). “Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers”. Journal of Adolescent Health, 66: 699–704.

Ethics and legislation

  1. Maung, H. H. (2024). “Gender Affirming Hormone Treatment for Trans Adolescents: A Four Principles Analysis”. Journal of Bioethical inquiry.
  2. Ashley, F. (2022). “Adolescent medical transition is ethical: An analogy with reproductive health”. Kennedy Institute of Ethics Journal, 32: 127–171.
  3. Beauchamp, T. L. and Childress, J. F. (1979). Principles of biomedical ethics. New York: Oxford University Press.
  4. The Human Medicines Regulation 2012. https://www.legislation.gov.uk/uksi/2012/1916/contents/made
  5. Swedish Medical Products Agency. https://www.lakemedelsverket.se/en/trading-pharmaceuticals/pharmacy/pharmacy-customers/prescriptions-within-the-eea
Updated on March 21, 2024

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