New Halifax pharmacy aims to bridge gap in LGBTQ health services

A new Halifax pharmacy aims to make LGBTQ patients feel empowered and respected with a broad set of services, which some hope could set a new standard for the rest of Nova Scotia.

Boyd's Pharmasave on Agricola Street officially opens Monday, fulfilling a long-held dream by pharmacist and owner Greg Richard.

Richard, who grew up in Miramichi, N.B., recently moved to Halifax with his partner, Stephen. The 28-year-old said he's wanted to be a pharmacist since high school, and owning his own business is key because it offers more flexibility.

He wanted to stand up and be visible about having an inclusive approach to people of all backgrounds and gender identities, Richard said, since those in marginalized groups have not always felt safe going into a pharmacy. They might have to educate the staff on queer health care, or remind them of their pronouns, Richard said.

"I think it's just important for people to know that it is a safe space, a place where we're educated and ready to welcome them," Richard said.

Richard is also one of the few pharmacists, if not the only, in the province to offer testosterone injections. Testosterone is a key part of gender-affirming hormone therapy for trans-masculine people, and is most commonly used as an injectable, although patches or gels are also an option.

Richard said he was inspired to get the training needed to offer the injections by a former patient in Fredericton, where he worked after graduating from Dalhousie University's pharmacy program. This patient asked Richard to perform a testosterone injection since their family doctor wasn't available, walk-in clinics were closed, and he didn't want to administer it himself. 

"It was that moment that I said, 'Clearly, there's a gap here.' And that's just one small piece of the puzzle," Richard said.

Richard wasn't able to help that patient because pharmacists in New Brunswick aren't regulated to perform those injections, but they are in Nova Scotia as long as they have the proper training.

People on testosterone need to have injections every one or two weeks, depending on their situation, so Richard said many inject themselves at home or visit a clinic or doctor's office. 

But the COVID-19 pandemic has made it especially tricky for people to access health care in person, Richard said, so having a pharmacist who is always open can make a big difference. It also takes some of the burden off doctors at busy clinics, he said.

While Richard said he can't speak for what every pharmacy offers, he hasn't heard of any others in the province who also offer the service. If there are others, there isn't an easily accessible database to find them. 

The Nova Scotia College of Pharmacists does not collect information on how many pharmacists have taken the additional training needed to offer such injections, said CEO and registrar Beverley Zwicker.

Most pharmacists are able to inject patients in their upper arms, like with a flu shot, Zwicker said. Those who have taken extra self-directed training can administer injections into other muscles in sites like the thigh or buttocks, which is where testosterone is injected.

Anecdotally, Zwicker said she has heard about "a number" of pharmacists taking this extra training, but that's not necessarily specific to testosterone.

She said the college is "very pleased" to see Boyd's offer a full range of services to help their patients, and in particular the LGBTQ community.

"We recognize that this community has specific health needs, and would benefit from a pharmacy that has made providing care to them a special area of focus," Zwicker said.

A 2018 study from Dalhousie University noted that "in several key areas, the primary health care needs of LGBTQ populations in Nova Scotia are not being met and this may in turn contribute to their poor health outcomes across the life course."

Besides offering injections or showing people how to safely do them at home, Richard said the pharmacy is visibly inclusive. 

This includes everything from hiring staff members of colour and those who are LGBTQ, to pronouns on name tags and intake forms where patients can specify their preferred name, pronouns and gender identities.

Even before Boyd's opened its doors, Richard said he was getting piles of email and messages, with some dropping by in person, from people looking to transfer to the pharmacy.

Richard said this reaction speaks volumes about the current need in the community.

Charlie Johnson was not surprised to hear about people going out of their way to move to Boyd's, adding he'd have loved having such an option when he was starting hormone therapy.

Johnson, who has been using testosterone as part of his gender-affirming transition for more than a year, said injecting at home is intimidating and not easy. In fact, he recently visited the Halifax Sexual Health Centre for a refresher on how he should be doing it.

He said there's a real need for people to be able to ask questions, get trained properly and have access to this kind of health care, which is "so scarce" in Nova Scotia and often has long wait times. When people start testosterone, Johnson said they often only get one or two sessions of instructions with their family doctor before being expected to inject at home.

Boyd's opening will bring a "big sigh of relief" for many people, Johnson said.

"This is going to change their lives in a very positive way. It's going to give a lot of people the confidence that they need to feel comfortable doing such a scary thing," Johnson said.

For Nik Basset, Boyd's is not only a key place to know where testosterone is in stock (Basset said there is currently a shortage), but opens up conversations around the need for better LGBTQ health care in general.

Basset, who uses they/them pronouns as a trans-masculine non-binary person, began testosterone a few months ago.

They'd love to see more doctors and health professionals get WPATH (World Professional Association for Transgender Health) training in Nova Scotia, or even have it mandated. The training allows clinicians to prescribe hormones.

As a staff person with the Youth Project, a Halifax non-profit supporting people under 25 around sexuality and gender identity, Basset said Boyd's could also help young people who can't keep injection materials at home.

The syringes, needles and a sharps container needed for injection create a barrier for people who have others in their home who don't know, or approve, of the therapy, Basset said.

Basset also said having Boyd's as a safe place for trans women to access hormone therapy could be "life-saving," since they disproportionately experience violence and discrimination even within the LGBTQ community. 

Feminizing hormone therapy includes taking estrogen, which is available in oral or patch forms.

While Boyd's is great for Halifax, Basset said they're thinking about how LGBTQ people in rural Nova Scotia still don't have this kind of access.

"[I'm] hoping this can kind of set an example of a standard, and how pharmacies and anyone offering support services need to take a bigger responsibility around cultural [responses]," Basset said.

That could include more education on gender and transition, Basset said, as well as how to better support Black and Indigenous patients, or those living with disabilities.

"This is kind of opening up a conversation about the responsibility that people offering services really do have," Basset said.

Richard said his goal is to set up Boyd's, named for his grandfather, as a community hub for decades to come and a pharmacy "for everybody" that could become like a family member.

"Just be there for the folks who visit us ... for the rest of my life," he said.