Gender Flashcards
Define transgender
someone whose gender identity is not congruent with the sex they were assigned at birth
what regular contraception is recommended for those on testosterone therapy?
progesterone only. Oestrogen antagonises the effect of testosterone
IU systems and injections may suspend menstruation. The coil can exacerbate menstrual bleeding
does testosterone therapy provide protection against pregnancy?
no
it is also is teratogenic if pregnant
if on testosterone therapy and in need of emergency contraception, what can be used?
either oral formulation
the coil may be considered but an exacerbate menstrual bleeding
For patients assigned male at birth treated with oestradiol, GNRH analogs, finasteride or cyproterone,
can it be relied upon as a method of contraception?
no but there may be a reduction or cessation of sperm production
define gender dysphoria in children
A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six points …
associated with clinically significant distress or impairment in social, school or other important areas of functioning
define gender dysphoria in adolescents and adults
A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least 2 points …
gender identity disorder of childhood
The individual shows persistent and intense distress about being a boy, and has an intense desire to be a girl or, more rarely insists he is a girl
present for at least 6m and not yet reached puberty
define sexual maturation disorder
the patient suffers from uncertainty about his or her gender identity or sexual orientation
assc w/ or causes anxiety or depression
what is the difference between DSMV and ICD-10 in diagnoses
DSMV focuses on roles in childhood compared to physical sex characteristics in adults
ICD10 more focussed on physical sex characteristics even in childhood
an adult who considers themselves non-binary can meet the DSM-V criteria but not the ICD-10
ICD-11
will be published in Jan 2022 and will rename transsexualism as Gender Incongruence
and declassify it as a mental health disorder and classify it as a sexual health disorder
what is identity?
how they feel
what is expression?
how they communicate that feeling
history taking for gender identity
- describe your gender identity
- how + when did you realise that your experience is different to others?
- has your identity changed over time? Was there any significant life events that influenced your gender identity?
- How do you fell about your gender now?
- How does your gender impact work, relationships, family or other aspects of life?
- How do you feel about your physical sex characteristics above/below the waist? Have you any strong feelings about needing to change these?
history taking for gender expression
- Any activities you did as a child/adult that could be not typical for you assigned biological sex? How did other people view this?
- did you prefer to be around any particular gender as a child? Is that different now?
- Have you ever cross dressed? What was that experience like? What do you imagine it would be like?
- If you could change your appearance to more closely match how you feel, what would this look like?
- Have you ever taken any hormones or had any confirmatory surgery? What was this like?
perceptions of others history taking
- how do you want to be perceived? how important is it that how you feel and how others perceive you match?
- are there any social barriers to you expressing yourself in a way you feel comfortable
history taking structure
1) gender identity
2) gender expression
3) perceptions of others
4) physical and emotional
5) social stability
6) trauma
7) coercion/control/undue influence
8) paraphilias - fetishistic transvestitism as differential dx
9) self-harm suicide
10) harm to others, criminal record
what service is available?
U18 referred to a Gender Identity and Development Service (Tavistock/Portman clinics in London + Leeds)
approaching 18, they are transferred to an adult service e.g. Porterbrook Clinic in Sheffield
adult gender dysphoria care pathway: 0-6m
- 2x2 assessments (one must be with a medic
- MDT discussion if required
adult gender dysphoria care pathway: 6m
hormones and voice and communication therapy
adult gender dysphoria care pathway: 12m
facial hair depilation or mastectomy w/ chest wall reconstruction referrals
adult gender dysphoria care pathway: 18m
lower (genital reconstruction) gender confirmatory surgery pathway
adult gender dysphoria care pathway: 3-5yrs
transition complete (best case scenario)
will hormones irreversibly affect fertility
yes
patients can access fertility preservation services through their GP if their CCG funds for it
