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New Article Offers First Clinical Guidance For Prescribing Psychiatric Medications With Transgender And Gender Diverse Patients

BOSTON, April 20, 2022—An article published online today in JAMA Psychiatry offers guidance for clinicians prescribing psychiatric medications with transgender and gender diverse (TGD) patients. The article is believed to be the first peer-reviewed summary of psychopharmacological guidance for prescribing clinicians working with TGD patients, who experience high rates of psychiatric morbidity due to minority stress and physical gender dysphoria and have unique psychosocial and physiological needs as compared with their cisgender peers.

“Psychiatric prescribers need to be aware of the ways in which some commonly prescribed medications may potentially interact with other medications included in a gender-affirming treatment regimen, and how to tailor clinical recommendations accordingly,” said article senior author Dr. Alex S. Keuroghlian, who directs the National LGBTQIA+ Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program.

The paper addresses the potential complications when medications such as clozapine, chlorpromazine, or quetiapine—which are used to treat schizophrenia, bipolar disorder, manic-depression, and other mood disorders—are combined with spironolactone, which is often prescribed to trans feminine patients because it suppresses hormones like testosterone. Other topics addressed in the article include the improved mental health outcomes associated with gender-affirming hormones, the substantial dysphoria experienced by some trans feminine patients due to spontaneous erections, and the need for careful monitoring of blood levels of gender-affirming hormones and mood-stabilizing medications. For example, estrogen has been shown to reduce the concentration of lamotrigine, which is sometimes prescribed to mitigate the mood swings associated with bipolar disorder.

“Psychiatric prescribing clinicians have a responsibility to be familiar with the most up-to-date scientific and clinical information,” said lead study author Dr. Jack Turban, Chief Fellow in Child & Adolescent Psychiatry at the Stanford University School of Medicine. “Unfortunately, most clinicians don’t have specific training in how to care for transgender and gender diverse patients.”

“Transgender and gender diverse patients can benefit enormously when clinicians collaborate on treatment plans and engage in conversations about whether and how psychiatric medications may interfere with the effectiveness of gender-affirming hormones,” said study co-author Marija Kamceva, BS. “Patient-centered approaches that prioritize gender affirmation can greatly improve the therapeutic relationship and help increase adherence to psychiatric treatment regimens.”

“Psychopharmacologic Considerations for Transgender and Gender Diverse People” is available online here.

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