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Repro. Med 4 > Caring for Transgender Pts > Flashcards

Caring for Transgender Pts Flashcards

1
Q

____ is one’s sense of being male or female

A

gender identity

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2
Q

___ is how one thinks of oneself in terms of whom one is romantically or sexually attracted to

A

Sexual identity

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3
Q

___ is an individual’s expression of gender

A

Gender presentation

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4
Q

___ is a term that can apply to a wide variety of cross-gender behaviors and identities

A

Transgender

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5
Q

T/F: Transgender is not a medical or psychiatric term

A

T

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6
Q

Is the word transgender an adjective or noun?

A

adjective (transgender person)

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7
Q

What the the term for transitioning from Male to Female (MTF)

A

transfemale

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8
Q

What the the term for transitioning from Female to Male (FTM)

A

transmale

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9
Q

Transsexual is a ____ term.

This is a patient who is seeking ___ and/or _____, which may include a legal change in gender status

A

medical (adjective, not a noun)
hormonal
surgical body modification

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10
Q

Transvestite is a ____ term

A

Psychiatric

**Males who wear female clothing for sexual gratification and may experience significant distress

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11
Q

What is required for dx of transvestite?

A

For women or men

  • must cause significant distress
  • clothing worn for sexual gratification
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12
Q

What is the “golden rule” for caring for transgender pts?

A

Tx the person in front of you

  • Respect their gender identity
  • Provide screening/prevention for the anatomy that’s present regardless of presenting gender or self-identification
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13
Q

___ % of transgender pts have attempted suicide

A

41%

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14
Q

__% of transgender pts have experienced family rejection

A

57%

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15
Q

___ % of transgender pts have lost a job because of their identity

A

55%

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16
Q

___% of transgender pts have been harassed/bullied in school
___ % experience physical assault
___% experience sexual assault

A

harassed/bullied: 51%
physical assault: 61%
sexual assault: 64%

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17
Q

___ % of the transgender population have been homeless at some point in their lives

A

19%

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18
Q

There are higher rates of ___, ___, and ___ use (behaviors) in transgender pts

A

HIV (4x)
smoking
Alcohol use

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19
Q

__% of transgender pts postpone medical care due to discrimination

A

28%

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20
Q

T/F: Not every transgender pt will want hormone tx

A

T

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21
Q

What kind of hormones will you give the following pts interested in transitioning?
Male: ______
Females: ____

A

Estrogens (progesterones)

Androgens

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22
Q

Is hormone tx for sexual transitioning considered on or off-labeled?

A

Off-labeled

**code for tx of gender dysphoria

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23
Q

What pt education do you need to provide for transgender pts?

A 
expectations 
risks
long term considerations
medications 
fertility (may want to consider banking)
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24
Q

T/F: Minors can qualify for emancipation for hormone therapy to help them transition

A

F: This does not exist

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25
Q

Is oral or non-oral estrogen preferred?

A

non-oral (avoid 1st pass)

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26
Q

What are the estrogen therapy options for male to female ?

A

sublingual, transdermal, injectable

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27
Q

What population do you need to be cautious about tx w/ estrogen while transitioning?

A

smokers >35 y/o

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28
Q

After orchiectomy, (lower/higher) doses of hormones are needed

A

lower

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29
Q

What do you need to monitor during hormone therapy in male to female transition?

A

liver fxn

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30
Q

What are the effects of progesterone in male to female transitions?

A 
\+ effects on nipple areola and libido
\+/- mood effects (depression)
wt gain
CVD risk
bone loss
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31
Q

What are the names of the anti-androgen drugs that can be used in male to female transition? (x2)

What must be monitored while taking each?

A

spironolactone –> potassium

finasteride (5a-DHT antagonist) –> adjunct for hair loss

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32
Q

What changes in odor may a pt notice when transitioning from male to female?

A

sweat/urine odor changes

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33
Q

What skin changes occur in male to female transitioning?

A

skin: dry, thin, easier bruising, small pores w/ less oils

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34
Q

What breast changes occur in male to female transitioning?

A

breast buds develop

35
Q

What happens to weight distribution in male to female transition?

A

wt distribution changes, to hips and thighs

wt gain or wt loss can occur

36
Q

What muscular changes occur during male to female transition?

A

decreased muscle mass (strength decreases)

37
Q

What hair changes occur during male to female transition?

A

body hair decreases in thickness and distribution
grows slower
**will not completely go away

38
Q

What can a pt do to remove hair during male to female transition?

A

electrolysis, shaving, laser, waxing, plucking, etc

39
Q

What anatomical things do NOT change in male to female transition?

A

bones

** ligaments can change (new shoe size)

40
Q

What changes occur in the male genitalia while that are transitioning to female?

A

decrease in erections
testicular atrophy
permanent sterility

41
Q

T/F: Emotional changes can be significant when a male is receiving hormonal therapy

A

T

- psychotherapy may or may not change

42
Q

What skin changes occur in female to male transition?

A

Skin thicker, more oily, larger pores, acne, increased sweating (odor changes)

43
Q

What breast changes occur in female-male transition?

A

Breasts decrease (wait 6 mo before surgery)

44
Q

What happens to wt distribution in female-male transition?

A

More fat around abdomen and thighs

45
Q

What musculature changes occurs in female-male transition?

A

Increased muscle mass and strength

46
Q

What hair changes occurs in female-male transition?

A

Hair increases in thickness, darkens and grows faster

pattern will mimic other men in family (male pattern baldness can occur)
** takes 5 years to get final results

47
Q

What are the testosterone forms for female-male transition?

What do you need to monitor?

A

IM, patch, gel
**dose titrated to effect

liver, blood counts

48
Q

What can occur if there is too much testosterone is given to a pt in female-male transition?

A

Too much can convert to estrogen = undesired feminization

49
Q

T/F: Trans-men cannot get pregnant

A

F, they can (use contraception!)

**fertility if impaired, but not absent

50
Q

What can you use to tx male pattern baldness?

A

Finasteride

Topical minoxidil

51
Q

How can you tx low libido in female-male transition?

A

Low dose SSRI

52
Q

What gynecological changes can occur in female-male transition?

A

Clitoral enlargement

Lighter, shorter periods (eventually stop)

53
Q

PCO-like picture is common because androgen exposure leads to ____
Pts may need evaluation for uterine _____

A

Anovulation

Hyperplasia

54
Q

Are pt transitioning from female-male still at risk for ovarian/cervical CA

A

Yes

** pap smear, pelvic exam is still required

55
Q

Many recommend hysterectomy w/in ___-___ years of hormone initiation because of tendency to recruit follicles but not ovulate them

A

5-10 yrs

consider when fertility is not an issue, pt is >40 yrs, surgical risk is low

56
Q

Why is there an increase in risk of heart dz and HLD in female-male transitioning?

A

Androgen effect

57
Q

Frequency of visits depends on where in the transition your pt is: initially every __ weeks, tapering as pt progresses/stabilizes

A

4 weeks

58
Q

What should be checked at routine medical visits for pts transitioning, no matter who they are?

A 
Monitor BP
Hormone side effects
Emotional changes
Weight
QOL
59
Q

What should be checked at routine medical visits for transmen?

A

Osteoporosis (consider Vitamin D and calcium)
Assess menses
- Add progesterone if a period continues beyond 3 mos, and consider endometrial bx

60
Q

What should be checked at routine medical visits for transwomen?

A

Check potassium if on spironolactone

61
Q

What annual exams need to be performed for transwomen?

A

Mammogram starting 40-50 y/o

Rectal exam w/ PSA from 50 y/o (NEED DRE)

62
Q

T/F: Pap smears in postoperative for transwomen pts are unnecessary

A

T: vaginoplasty does not create a cervix at risk for HPV

63
Q

What “maintenance” steps must be taken in transwomen after vaginoplasty?

A

Pt must dilate vagina x3-4 daily w/ dilators (sexual activity counts)

64
Q

What annual exams need to be performed for transmen? (a lot)

A

T levels q 6 mo (midcycle bt injxns)
- check troughs is mood or energy levels are low
Hemoglobin (use male level to compare)
Annual lipid assessments for pts > 30
Annual mammogram starting age 40 – 50
Bimanual pelvic exam (q1-2years)
Pap (q 2-3 yrs)–> warm pathologic
pelvic U/S (for new vaginal bleeding w/ uterus)
TSH (@ age 45, q3 yrs)
Bone density screen 5-10 years after starting T

65
Q

What baseline labs do you need for transwomen? (x4)

A 
Fasting lipids (if on an oral estrogen regimen)
Potassium and creatinine (if on spironolactone)
Liver function
66
Q

What baseline labs do you need for transmen

A

hemoglobin
lipids
Testosterone (use male levels to evaluate)

67
Q

What can causes vaginal bleeding in transmen that is not CA?

A

Missed testosterone doses
Excessive testosterone dosing leading to increased Estrogen levels
Weight changes
Thyroid d/o

68
Q

How should you screen transwomen currently taking estrogen for CAD/CVD?

A

Closely monitor for cardiac events or sxs

  • especially first 1-2 yrs of hormone therapy
  • *Use transdermal estrogen in pts at high risk (including pre-existing CAD)

HTN: monitor BP every 1-3 months
- is BP needs lowered, use sprionolocatone

69
Q

When do you need to screen transmen for CVD?

A

Not on T –> tx hyperlidipidemia normally

Planning to start hormones w/in 1-3 yrs
- get SBP<130, DBP <90, LDL <135

Currently taking T

  • same as transwomen
  • lipids: daily topical, biweekly IM best for hyperlipidemia LDL<135
70
Q

How should you screen a transwoman taking estrogen for DM?

A

Annual test

  • GTT or A1C if impaired glucose
  • use normal guidelines to tx
  • decrease estrogen if glucose is difficult to control
71
Q

How should you screen a transman taking testosterone for DM?

A

Screen and tx as non-transgender pts

- may screen for PCOS

72
Q

Why is DM a “touchy” subject for a transman?

A
  • may intentionally gain weight to obscure breast/hip appearance
  • they may not realize the increased metabolic demands when taking T
73
Q

Transwomen are at risk for developing ____ in order to maintain a slight build.

A

eating d/o

74
Q

How should you supplement all trans pts who take cross-sex hormones and/or have had or anticipate gonadectomy

A

Supplemental calcium and vitamin D

75
Q

Transmen taking T are at risk for _____ rupture, especially in transmen involved in strength training.

How can you educate them to avoid this complication?

A

tendon

increase weight load gradually
Emphasize stretching

76
Q

What sexual Hx question are important for transgender pts?

A 
# of partners
sexual orientation changes (this can change as hormonal changes occur) 
contraception
self destructive behaviors
77
Q

When is HIV and Hep B/C screening recommended for transgender pts?

A

high risk: every 6-12 months

low risk: 1x during lifetime

78
Q

How often should a transgender pt w/ high risk behaviors be screened?

A

Every 6 mo (G/Cl, syphilis)

79
Q

What type of tissue is present in neovaginas in transwomen?

A 
Skin (not mucosa)
If mucosa (usually urethral or colon)
80
Q

Mammogram should be preformed on Transwomen on hormones for ___+ years and at least ____ y/o, unless strong FHx of breast or ovarian CA –> Screen earlier

A

30+ yrs 50 y/o

81
Q

When should Transmen have bone density screening?

A

> 60 yo and testosterone < 5-10 yrs

82
Q

T/F: There is no upper age limit for beginning hormones?

A

T

83
Q

Who usually sees slower results: transmen or transwomen?

A

transmen

Repro. Med 4 (7 decks)

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