Gender Affirming Care Flashcards
What are the 3 diagnostic criteria for gender dysphoria?
- Incongruence between assigned gender and known gender > 6 months
- Distress or impairment of function
- Age > 18 or >16 with guardian consent
Is hx of a thromboembolism a contraindication to estrogen therapy?
No
What are contraindications to estrogen therapy?
Acute unstable physical or mental health condition
Active estrogen sensitive neoplasm
What are contraindications to testosterone?
Pregnancy
Acute unstable physical or mental health condition
Untreated polycythemia
Active testosterone sensitive neoplasm
Goal serum estradiol in estrogen based therapy?
50-200 pg/mL
Goal T in estrogen based therapy?
< 55ng/dl
What is the strongest, purest form of estrogen?
17-beta-estradiol
What route of administration of estradiol is the cheapest?
Oral/sublingual estradiol
What is the safest route of administration of estradiol if a patient has comorbidities?
Transdermal
After estrogen therapy is started, the expected onset of psychological benefits occurs?
Immediately
After estrogen therapy is started, the expected onset of breast development occurs?
3-6 months
What is the effect of estrogen on genetalia?
Decreased testicular volume, reduced sperm and semen quantity.
What is the effect of estrogen on body fat?
Increased subq fat
What medications can be used for anti-androgen therapy?
Spironolactone Finasteride Dutasteride Progesterone GnRH analogs (leuprolide)
What class of medications can be used to block breast development in the setting of estrogen based therapy?
SERMs
List some adverse effects to estradiol.
VTE Osteoporosis Increased CV risk Insulin resistance Prolactinoma Breast cancer Psychological
If spironolactone is used as an anti-androgen, what metabolic findings should you worry about?
Hyperkalemia
What is the goal range of T in testosterone therapy?
400-800mg/dl
Are changes seen more rapidly in estrogen therapy or testosterone therapy?
Tesosterone
How often should estrogen levels be checked in testosterone therapy?
They don’t have to be checked
What are the routes of administration for testosterone?
IM/SC
Transdermal patches
Transdermal gels
What form of testosterone is rarely used due to its high cost?
Transdermal patches
What adverse effect of testosterone needs to be checked for every 3 months?
Polycythemia
What medication would you consider in a patient undergoing testosterone therapy who begins to have hair loss?
Finasteride
