Care of Transgender and Gender Diverse Clients Flashcards
describe gender dysphoria
discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth
Transsexual, transgender, and gender nonconforming individuals are not inherently “disordered”, rather the _______________, when present, is the concern that might be diagnosable and for which various tx options are available
distress of gender dysphoria
list 3 treatment options for patients with gender dysphoria
changes in gender expression
endocrine therapy to feminize or masculinize the body (gender affirming hormone therapy)
surgery
psycho/social therapy
voice and communication therapy
lifelong preventative and primary care
_____ and _____ increases risks associated with endocrine therapy
smoking and obesity
in males, estrogen reduces ____________ and ______/ ____ in a cumulative, dose dependent manner
testicular volume
reduces motility and density
Males: estrogens reduce testicular volume and reduce motility and density in a __________________
1. cumulative, nondose dependent
2. cumulative, dose dependent
3. noncumulative, nondose dependent
4. noncumulative, dose dependent
cumulative, dose dependent manner
what is the first line treatment for gender dysphoria in adolescents
leuprolide
what is a reversible emans of suppressing unwanted irreversible body chages
leuprolide
whawt is leuprolide? how does it work?
GnRH agonist
causes receptor downregulation = suppresses release of FSH and LH
AEs of leuprolide
painful injections, hot flashes, low mood/ fatigue, loss of bone mineral density
Feminizing GAHT includes 3 options
estrogens
antiandrogen / blockers
progestins
antiandrogens/ blockers are for (3 populations)
adults with testes
youth not on GnRHa
when the client’s goal is to approximate cisgender hormones
what options are there for masculine GAHT
testosterone +/- blockers
list the 3 irreversible changes of feminizing GAHT
breast development
possible loss of fertility
possible decreased adult height (if E started before completed skeletal growth)
list the 3 reversible changes of feminizing GAHT
thinning of body hair and skin softening
fat redistribution
decreased libido and erections
what types of estrogen are there for GAHT
estradiol oral
estradiol transdermal
compounded estradiol valerate or cypionate
what is the most commonly prescribed estrogen for GAHT
estradiol oral
estradiol transdermal is recommended for
trans women >45yrs, hx VTE, tobacco use, BMI =>27, post op status
AEs of estrogens in GAHT
weight gain, HPTN, hypertriglyceridemia, VTE, ED, infertility, RFs (CVD, cholelithiasis, T2D, hyperprolactinemia)
antiandrogens minimize the _____ needed to suppress T
dose of E
what feminizing effects do antiandrogens have?
breast development and reduction in androgen sensitive face and body hair (if prevented before it starts in puberty, don’t need removal later)
how does spironolactone act as an antiaandrogen
blocks peripheral androgen receptors- will not always affect a significant change in blood T levels
spironolactone AEs
hyperkalemia, dizziness, GI distress
which 2 antiandrogens are used for GAHT
spironolactone, cyproterone
which has more rapid suppress of T
1. spironolactone
2. cyproterone
2
cyproterone MOA
Androgen receptor blockade, also inhibits production of LH
cyproterone AEs
severe liver dysfunction (high dose), depression (first 6-8wks), rare meningiomas
which of the following is false about progesterone GAHT
1. supplementation in feminizing tx is controversial due to side effect of lipid changes
2. may suppress LH and T
3. effects on breast, nipple, and areolae development are likely due to edema
4. AEs include depression and weight gain
1- no clear impacts demonstrateed in clinical trials
what is an orhciectomy
removal of testes
what is a permanent way to prevent sperm production and puberty + avoid being on blockers
orchiectomy
what are some irreversible changes with masculinizing GAHT
clitoral growth, deepened voice, atrophy of breast tissue (lose glandularity, but generally does not lose mass or circumference)
with masculinizing GAHT, there is atrophy of breast tissue with loss of _____, but generally does not lose ________
loses granularity
generally does not lose mass or circumference
what are some somewhat reversible changes with masculinizing GAHT
altered body fat- muscle mass ratio (more upper body muscle), cessation of menses, increased libido, coarse hair growth (androgen dependent areas)
what T supplementation has superior efficacy and a lower price
IM testosterone cypionate or enanthate qwk
regarding T supplementation for GAHT
1. IM testosterone cypionate may have cyclic variations in effects with 2-4wks dosing
2. oral testosterone undecanoate may have more peaks and troughs than parenteral
3. oral testosterone undecanoate may have less peaks and troughs than parenteral
4. IM testosterone cypionate may have cyclic variations in effects with q1wk dosing
5. 1+2
6. 3+4
5
AEs of testosterone for GAHT
polycythemia, infertility, acne, androgenic alopecia, HPTN, sleep apnea, weight gain, with RF (CVD, hypertriglyceridemia, T2D)
what is a metoidioplasty
testicular prosthesis
what is a phalloplasty
testicular/ penile prosthesis
