The Impact of Physician-Pharmacist Collaborative Drug Therapy Management in Gender-Affirming Care.

PURPOSE: To describe the implementation and early experience of a pharmacist-led collaborative drug therapy management (CDTM) service delivering gender-affirming hormone therapy (GAHT) and integrated preventive care within an urban safety-net hospital.

SUMMARY: A CDTM pilot program was implemented in November 2023 at the Pride Health Center within NYC Health + Hospitals/Bellevue. Through collaborative agreements with primary care physicians, a board-certified ambulatory care pharmacist independently initiated and titrated hormone therapy and concurrently managed HIV prevention and treatment, sexually transmitted infections, and chronic disease states. Protocols developed jointly with physicians specified medications and laboratory tests the pharmacist could order independently. Between November 2023 and February 2025, 70 patients enrolled and completed 223 visits, during which the pharmacist documented 573 interventions, including 76 GAHT initiations, 28 PrEP initiations, 20 DoxyPEP initiations, and management of 62 adverse drug reactions under protocol. Among 58 patients completing a satisfaction survey, all reported feeling respected and supported by the pharmacist, and 95% strongly agreed they were pleased with the service.

CONCLUSION: A pharmacist practicing under CDTM independently initiated and managed gender-affirming hormone therapy while delivering integrated preventive care in a safety-net setting. The model was well received by patients and may be replicable at institutions with established LGBTQIA+ services and collaborative practice frameworks.