Exam 2-Care for a patient with Gender Dysphoria Flashcards
gender dysphoria
strong persistent identification with the opposite sex and desire or perception that one is of that gender. persistent discomfort about one’s assigned sex or sense of inappropriateness in the gender role of that sex.
-physiological distress due to the incongruence between one’s experienced and assigned gender at birth. NOT ALL INDIVIDUALS WITH GENDER INCONGRUENCE EXPERIENCE GENDER DYSPHORIA!
-major discrimination and health care disparities!!!
teamwork and collaboration
working toward recovery
-align their physical state to their true gender identity
-hormones may be used to feminize or masculinize (estrogen and testosterone)
-surgical procedures that are increasing in possibility as third-party payers are starting to cover the cost
-treatment aimed at supporting individual’s experienced gender identity: may related to psychological support, medical treatment (hormones. and/or surgery), and legal aspects of care.
clinical manifestations of gender dysphoria
go hand in hand with:
-anxiety and depression
-poor self-esteem
-an increased risk of self-harm and suicidality
-substance use disorder
-preference for gender-affirming clothing and roles
-significant distress affecting daily life
can be explained by dissatisfaction with the gender that one was born with
-transsexualism: another manifestation that can be defined as extreme gender dysphoria that has persisted “without fluctuations for at least 1-2 years”
nursing considerations
important to implement therapeutic communication when caring for transgender individuals and RN should a judgement free space and an unbiased tone.
-ask pronouns/name preference
-use gender inclusive language and build rapport
-providers should have conversation about the patient’s comforts/discomforts before physical exams: request permission throughout the exam and explain eery step
-complete mental health screening and offer support
-ensure patient has good support
-importance of nursing support and advocacy for the transgender community: help provide sense of community and get connected
-collaborate with patient for personalized care plan including access to appropriate mental health services and gender-affirming medical interventions
DSM 5 diagnosis criteria
criteria assess how significant and persistent the distress is and its impact on daily life
-children must meet at least six criteria
-adolescents and adults must meet at least two criteria
gender dysphoria often begins in childhood but may not be fully recognized until puberty or later.
insurance approval for gender-affirming care
insurance approval for hormone therapy and gender-affirming surgery can be extensive and challenging to navigate!! approval for insurance coverage varies between different plans and companies.
patients and parents must apply for pre-authorization before undergoing any treatment
-includes 2 letters from healthcare providers (1 from MH provider and 1 from either endocrinologist or PCP) detailing why treatment option is necessary
-patients must submit letter to explain why a treatment option is necessary and why refusing to provide coverage may be detrimental to health.
follow up with insurance company for approval (may deny pre-authorization, especially if dealing with out of network providers)
treatments and medication s for transfeminine individuals
estrogen therapy (estradiol)
-effects: breast development, fat redistribution, reduction in muscle mass and strength, decreased libido and sperm production
anti-androgens (blocks testosterone)
-effects: reduce facial and body hair, reduced acne, decreased libido
-goal: reduce testosterone and develop female secondary sex characteristics
treatments and medications for transmasculine individuals
testosterone therapy
-effect: deepening of voice, increased muscle mass, body fat redistribution, increased body and facial hair, absence of period
-goal: increase testosterone to develop secondary sex characteristics
puberty blockers: GnRH (Leuprolide)
-effect: temporarily stops puberty to allow time for gender identity exploration
