12.2 Transgender Health Flashcards
What is the definition of transgender?
A word used to describe someone whose gender identity does not correspond with the sex that they were assigned at birth
What is the definition of a cisgender man?
- If you were born with a penis and identify as a man
- Can be sexually attracted to men & women etc
What is the definition of a cisgender woman?
- If you were born with a vagina and identify as a woman
- Can be attracted men & women etc
What is the definition of a transgender man?
A trans man is a man who was assigned female at birth
What is the definition of a trangender woman?
A trans woman is a woman who was assigned male at birth
What is the definition of a non-binary person?
- Nonbinary gender is an umbrella term to describe any gender identity that does not fit into the gender binary of male* and *female (not entirely male or female)
- Need to use the pronouns they, them, theirs
What is the definition of androgynous?
Identifying and/or as neither specifically masculine or feminine
What is the definition of gender fluid?
One who embraces fluidity of gender identity
What is the definition of agender?
One who does not ideentify as a particular gender
What is the definition of gender non-conforming?
One whose physical or behavioural characteristics do not correspond to the traditional expectations of their gender
What is the definition of genderqueer?
One who does not identify with a single fixed gender
What is the definition of bigender?
Identifying as two genders
What is definition of trigender?
Identifying as 3 genders
What is the definition of neutrois?
Gender neutral
What is the definition of a demigirl & demiguy?
DEMIGIRL
Identifying particularly as a girl but not wholly
DEMIGUY
Identifying particularly as a guy but not wholly
What is the definition of cisgender?
Identifying as the gender you were assigned to at birth
Explain the minority stress theory
Explain mental health in trans people
- Almost half of trans people have attempted suicide at least once
- More than half are diagnosed with depression
- Thus, are more at risk of:
- Threats
- Violence
- Alcohol/substance abuse
- Stress
- Anxiety
- Delayed cancer diagnosis
Explain the short term & long term management of mental health (depression) in trans people
Explain the trouble of being referred to a NHS gender identity clinic & what happens following referral
- Waiting times are VERY LONG
- Can be at least 100 weeks long in some clinics
- Be helpful to dictate the letter with the person in the room to check if they are OK with the language being used
What kind of transitions can be done to a trans person?
- Social Transition
- Medical Transition (Hormones)
- Surgical Transition
- Electrolysis/Laser (hair removal)
- Speech and Language Therapy
- Gamete Storage (10 years)
- Psychology
What kind of hormonal help can trans people get & why?
- Bridging prescriptions (so don’t self-medicate from un-regulated sources)
-
AFAB (assigned female at birth)
- +/- anti-androgen (usually GNRH analogue)
- Testosterone
-
AMAB (assigned male at birth)
- Estradiol
- +/- anti-androgen (usually GNRH analogue)
What kind of surgery can trans people get?
AFAB (assigned female at birth)
- “Top surgery” - Bilateral mastectomy with male chest reconstruction
- “Lower surgery” - phalloplasty or metoidioplasty; scrotoplasty; Hysterectomy
AMAB (assigned male at birth)
- “Lower surgery” - Orchiectomy, Penectomy, Vaginoplasty, Vulvoplasty
- Laryngeal surgery
- Facial feminisation surgery
- Breast augmentation
Where should a trans person be nursed?
- Transgender patients should be nursed according to their full-time gender expression and not according to their sex assigned at birth
- They should be asked if they would like a side room for increased privacy if possible
- Medical staff must be careful to maintain their privacy
- Using appropriate pronouns* and the *patient’s preferred name (even if this does not match the name on the medical records) is very important
What is the risk of having a trans person on estradiol?
- There’s a high risk of a venous thromboembolism
- If there is high risk switching to transdermal estradiol is advisd (LOWER risk of VTE)
- Seek help from gender identiy clinic or endocrinologist
-
Hypertriglyceridaemia
- Increase triglycerides = increased risk atherosclerosis & diabetes (Type II)
- Hypertension
What are the effects of estradiol on a trans woman?
- Breast growth
- Body fat moves generally from tummy to hips and thighs
- Less muscle bulk and less strength
- Less hair on body and face
- Stop losing more hair from your head (please note: scalp hair that has already been lost does not grow back)
- Softer skin and less oiliness of your skin
- Smaller testicles
- Fewer sperm are produced - affects fertility
- Lower libido (less interest in sex)
- Difficulty in achieving an erection for use in sexual activity
- Fewer erections when not involved in sexual activity
- Reduced level of haemoglobin (Oxygen-carrying pigment in red blood cells)
What are the effects of testosterone treatment (hormone) on trans males?
- Body fat moves generally from hips and thighs to tummy
- Increase in size and strength of muscles
- Increase in amount and thickness of hair on body
- Increase in amount and thickness of facial hair
- Oilier skin and acne (spots on face, neck and back)
- Voice deepens
- More red blood cells are made
- Menstrual period bleeding stops
- Clitoris growth (on average by about 1-3 cm)
- Increased sex drive
- Vaginal dryness and thinning of vaginal walls
- Head hair loss
What is the risk of having a trans male on testosterone?
-
Polycythaemia
- Increase amount of RBC can cause INCREASE risk of clots
-
Hyperlipidaemia (INCREASE in liver enzymes)
- Can lead to Type II diabetes
- Hypertension
- Cardiovascular disease
What tests would you do on monitoring a trans person?
- Blood pressure
-
Blood tests
- FBC
- U&Es
- LFT
- Fasting blood glucose/HbA1C
- Lipid profile
- TFTs
- Serum Testosterone
- Serum Estradiol
- Prolactin
- LH
- FSH
Every 4 months till a year
Every 6 months for next 3 years
Then annually
What is a GNRH analogue & what are the side effects?
Hormones – GNRH Analogue
- Reduce endogenous sex hormone production (oestrogen/testosterone)
- Generally safe and well tolerated in transgender patients as we are replacing their sex hormones
- When used in cisgender patients side effects could include osteoporosis, hot flushes, excessive sweating (especially at night)
Side Effects
- Injection site reactions (redness, swelling)
- Headaches, dizziness or nausea (sickness)
- Mood changes
- Lower energy levels
- Loss of libido (interest in sex)
- Joint or muscle pain
(IM injection/SC implant)
Explain screening in the transgender population
- For non-binary patients
- Consider what organs patient has
- If patient no longer wants to be invited to screening they can opt out
Cervical Cancer (screening)
- NOT required for trans men that had total hysterectomy (is the surgical removal of the uterus and other female structures)
- Trans men with a cervix offered screening at the same frequency as cisgender women
- Trans women do not need screening as they do not have a cervix
Breast cancer (screening)
- Transgender men aged 50-70 should have breast screening if they still have breast tissue (if they have had chest masculinising surgery they may not have enough breast tissue to effectively screen but should still be chest aware)
- Transgender women aged 50-70 should be invited to have breast screening
- Hormone treatment - increased risk of breast cancer in trans women compared with cisgender men, and a lower risk in trans men compared with cisgender women
AAA (screaning)
- Transgender women aged 65 should have screening for a AAA
- Transgender men do not require screening
