Instrumento de cuidado farmacêutico para pessoas trans: desenvolvimento e validação.

Abstract

Introduction: For the trans population, hormone therapy is one of the main initial alternatives for achieving gender-related physical expectations. However, the use of hormones for gender affirmation can carry risks, making monitoring by a multidisciplinary team essential. In this context, pharmaceutical interventions emerge as an alternative to promote quality and safety of services provided to this population. Objective: To develop and validate a pharmaceutical care tool for trans people using hormones for gender affirmation. Method: The study was conducted in two phases. The first is a scoping review of the literature. The search covered gray literature and databases such as PubMed, EMBASE, Web of Science, Scopus, and Lilacs, with no restriction on publication date and in English, Portuguese, and Spanish. The research question was: What are the guidelines/interventions recommended by clinical protocols and guidelines for monitoring hormone use in transgender adults? The second phase consisted of a qualitative, descriptive study, divided into two phases. In the first phase, a pharmaceutical care instrument was developed for transgender people using gender-affirming hormones. The second phase involved content validation, conducted in two stages using the Delphi method. Results: In the scoping review, after applying the inclusion criteria, 27 articles were selected. Oral estrogen was the most cited in the feminization process (88.89%; n=24), while parenteral testosterone, in the forms of enanthate or cypionate (74.07%; n=20), prevailed in the masculinization process. The main beneficial effects included increased muscle mass (85.19%; n=23) in the masculinization process, as well as breast growth (92.59%; n=25) in the feminization process. The most common adverse effects were venous thromboembolism (74.1%; n=20) in the feminization process, while facial and body acne stood out (55.6%; n=15) in the masculinization process. In the second stage of the validation process, a panel of 11 experts participated in the first round and 8 in the second. With a high level of consensus on the validity indices, most items achieved a CVI of 100% and a CVC of over 80%. The final version of the instrument was organized into twelve dimensions. Conclusion: In the scoping review, in addition to individualizing care, studies recommend periodic assessment of testosterone, estradiol, blood glucose, lipid profile, liver function, prolactin, and hematocrit, as well as continuous monitoring for adverse effects. Furthermore, the instrument's content validation process, using the Delphi method, revealed high agreement among the experts, with most items achieving excellent results in the Content Validity Index (CVI) and Content Validity Coefficient (CVC).