Editor’s note: Maeleigh Tidd returns with another contribution to the Pharmaceutical Inequalities feature, this time co-authored with a graduate student colleague, Lucy Abrams. Mae and Lucy discuss the history of LGBTQ+ health in the USA, and situate existing LGBTQ+ rights within the international context. They subsequently discuss how pharmacists play a key role in providing gender-affirming care, and how this can be improved upon. The Pharmaceutical Inequalities series is funded by the Holtz Center and the Evjue Foundation.