GAH

Question 1

Feminizing Hormone Tx

Answer 1

Androgen blocker (Spironolactone > Asterides) + Estradiol (PO/IM/Patch, 17B is DOC)

Question 2

Estradiol Dosing

Answer 2

PO/SL: 2-4, max 8

Patch: 100 mcg (400 max) (better for increased TE risk)

IM: 20 mg Q2w, max 40

Question 3

Estradiol: AE/CI

Answer 3

AE
-Sexual dysfunction
-Migraines
-Weight gain
-VTE
-LFTs
-TGs
-Gallstones
-Hot flashes
-Mood swings

CI
-VTE
-Neoplasm (es sen)
-Hepatic impairment

Ethinyl estradiol = higher TE events

Question 4

Spironolactone

Answer 4

50-200 BID mg/d (max 400/day)

AE:
-High K
-Nocturia
-Orthostasis

CI:
-Addison’s

NOAH

Question 5

Asterides: 5aRi

Answer 5

Dutasteride over finasteride

For:
-Cannot tolerate spironolactone
-Partial feminization

Question 6

Feminizing Hormone Effects

Answer 6

Irreversible
-Breast growth
-Decreased spermatogenesis

-Slowing body hair growth
-Decreased muscle mass

Question 7

Masculinizing Hormone Tx

Answer 7

Testosterone monotherapy

Question 8

Testosterone Dosing

Answer 8

Cypionate (DOC): 25-50 Q1w or 50-100 Q2w

Patch or gel (good for ppl with mental health conditions)

Question 9

Masculinizing Hormone Effects

Answer 9

Irreversible
-Body hair growth
-Deepen voice
-Clitoral enlargement

-Loss of menses
-Increased muscle mass
-Vaginal atrophy

BED MAM

Question 10

Testosterone: AE/CI

Answer 10

CI
-Pregnancy

AE
-Weight gain
-Mood lability
-Migraines
-Infertility
-Acne

Question 11

When to base decisions on sex assigned at birth?

Answer 11

-Prostate/cervical/breast cancer
-Chest screening
-Renal function (first 6-12 mo of GAHT)