197-200. Transgender medicine Flashcards
Define what is meant by transexualism
A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of one’s anatomic sex, and a wish to have surgery and hormonal treatment to make one’s body as congruent as possible with one’s preferred sex.
Define what is meant by dual role transvestism
The wearing of clothes of the opposite sex for part of the individual’s existence in order to enjoy the temporary experience of membership of the opposite sex, but without any desire for a more permanent sex change or associated surgical reassignment, and without sexual assignment accompanying the cross-dressing.
Define what is meant by Gender Identity Disorder of Childhood
A disorder that usually first manifests during childhood (always well before puberty). Characterised by a persistent and intense distress about assigned sex together with a desire to be (or insists that one is) of the other sex. There is persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individuals own sex. Diagnosis requires a profound disturbance of the normal gender identity (e.g. not just being a tomboy/girly)
Define what is meant by fetishistic transvestism
The wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex. Is distinguished from transexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines. Can occur in the earlier phase in the development of `transexualism.
What are the 4 WPATH standards of care required for administration of hormone therapy?
- PERSISTENT, well documented gender dysphoria
- CAPACITY to make a fully informed decision, and to CONSENT for treatment
- AGE of majority in a given country
- If significant medical or mental health concerns are present, they must be reasonably well controlled
What hormone can be used in the suppression of menstruation?
Testosterone
What are some of the transmen effects of testosterone?
Low voice Increased libido Facial and body hair growth Increased muscle bulk Amennorrhoea Clitoromegaly Tendency to be more aggressive
What are the risks of using testosterone?
Liver dysfunction Increased risk of cardiovascular disease Diabetes Increased weight Mental health disturbance Polycythaemia (abnormal increase in number of circulating RBCs)
What hormone is given to transwomen?
Oestradiol
What are the transwomen effects of oestrogen?
Breast growth Softer skin Less facial and body hair Fat redistribution to hips More emotional
What are the risks of oestrogen use?
Increased risk for VTE
Increased weight
Increased blood pressure
Increased risk for breast cancer
What surgery is offered to transmen?
Hysterectomy
Release of enlarged clitoris and urethra redirected through (metoidoplasty)
Bilateral mastectomy and male chest reconstruction
Phalloplasty
What surgery is offered to transwomen?
Thyroid chondroplasty
Penectomy, orchidectomy, cliteroplasty, vulvoplasty
Colo-vaginoplasty
Breast augmentation
What are some of the female to male post-surgery problems?
Dislodgement of erectile cylinders
Mechanical failure of erectile mechanism - 10 yearly replacement
Hysterectomy and oophorectomy as well as vaginal ablation
What are some of the male to female post-surgery problems?
Neovaginal hair growth -> hairballs
Vascular occlusion of arterial supply to neoclitoris
Neovaginal stricture
Ongoing need for dilation
