Gender Affirming Care

Question 1

Can consider individuals for genital surgery when the person:

Answer 1

-has had a satisfactory social role change
-is satisfied about the hormonal effects
-desires definitive surgical change

Question 2

Gonadotrophin Releasing Hormone Analogues

Answer 2

Puberty blockers
-prevents the adverse mental toll of developing in the unpreferred gender (relief of anxiety/dep)
-later in adolescence or young adulthood
-explore transition without irreversible changes

Question 3

Feminizing Hormone Therapy Overview

Answer 3

Goals: suppress male sex traits, develop female sex traits

Approach: androgen blocker + estradiol

Question 4

Anti-Androgens

Answer 4

1. Spironolactone 200-400 mg/day
   -AE: hyperkalemia, nocturia, orthostasis
2. 5-alpha reductase (Dutasteride preferred)
   -for: intolerable to spirono, seeking partial feminization

Question 5

Estrogen Formulations and Dosing

Answer 5

DOC is 17β-estradiol (“estradiol”) products
-dose: 2 mg PO BID, 100 mcg if patch
-ae: low libido, migraines, weight gain, liver enzymes, HTN, hot flashes, mood swings, gallstones
-ci: VTE, liver disease, estrogen sensitive neoplasm

Question 6

Monitoring of Feminizing Hormones

Answer 6

-Estradiol 100-200
-Testosterone < 55
-K, renal, LFTs, lipids

6-12 mo (after initiation)

Question 7

Masculinizing Hormone Therapy Overview

Answer 7

Goals: develop male sex traits, suppress female sex traits

Approach: testosterone mono therapy

Question 8

Testosterone Formulations & Routes of Admin

Answer 8

-SQ/IM: Cypionate (DOC), 100-200 mg Q2wk or half wkly

-Transdermal: patch (irritation) or gel (secondary exposure), good option for pt with mental health conditions

Question 9

Testosterone AE and CI

Answer 9

-Polycythemia, Erythrocytosis
-Weight gain
-Mood lability
-Migraines
-Metabolic syndromes
-Increased sex drive
-Infertility
-Pelvic pain

CI: pregnancy

Question 10

Monitoring of Testosterone

Answer 10

-Testosterone: 300-1100
-Estradiol < 50
-CBC, LFTs, lipids

Question 11

When to Base Clinical Decisions on Sex Assigned at Birth?

Answer 11

1. Malignancy
   -transfem: prostate cancer, breast cancer
   -transmasc: chest screening, cervical cancer
2. Renal function (use sex for first 6-12 mo of GAHT then calc CrCl based on gender identity after)