Gender Affirming Care Flashcards
Being transgender simply means…
When someone’s gender identity is different than their sex assigned at birth
Cisgender simply refers to…
When a person’s gender identity matches their sex assigned at birth
Gender dysphoria refers to…
The incongruence between experienced/expressed gender, and assigned gender
Gender euphoria refers to…
Satisfaction and joy caused by congruence between one’s gender identity and their features, expression, or experiences
Puberty blockers MOA is to…
Pause/slow the effects of puberty - prevent changes such as voice lowering, breast growth, and periods
Effects of puberty blockers will vary, depending on…
How far puberty has progressed before starting the blocker
If puberty blockers are stopped…
Puberty will begin again - EFFECTS ARE REVERSIBLE
BUT if youth begins hormone therapy, they will experience puberty related changes associated with hormone prescribed
Common reasons why puberty blockers are prescribed include…
Prevent distress from development of secondary sex characteristics
Allow youth time to think about gender, transition, and goals without undergoing permanent/distressing puberty
May eliminate need for procedures like top surgery or hair removal
Most common puberty blocker is…
Leuprolide (Lupron)
In someone who is assigned male at birth, a puberty blocker will stop/limit…
Growth of facial + body hair
Deepening of the voice
Broadening of the shoulders
Growth of Adam’s apple, coarsening of features
Growth of gonads + erectile tissue
In someone who is assigned female at birth, puberty blockers will stop/limit…
Breast tissue development
Broadening of the hips
Monthly bleeding
In both AFAB and AMAB cases, puberty blockers will temporarily stop/limit…
Growth in height, and accumulation of calcium in the bones
Development of sex drive
Fertility
Strong emotions of adolescence
Risks associated with prescribing blockers…
Are not fully known…
May impact bone development and final height
Slowed growth of erectile tissue - can limit procedures like vaginoplasty
We do have strategies to deal with the slowed growth of erectile tissue
Risks associated with withholding blockers may include…
Distress
Dysphoria
Anxiety
Depression
Suicidality
Feminizing hormones involve the following…
Daily estradiol and androgen blocker (if testes are present)
Time for effect from feminizing hormones can take up to…
5 years
A patient on feminizing hormones should be monitored this frequently…
Every 3 months in the 1st year, then 1-2 times per year (or more if adjusting doses) - to monitor for appropriate signs of feminization and development of adverse reactions
While on feminizing hormones, midcycle serum testosterone and estradiol should be measured…
Every 3 months
While on feminizing hormones, serum testosterone should be…
Less than 1.74 nmol/L
While on feminizing hormones, serum estradiol should not exceed…
Peak physiologic range of 367-734 pmol/L
For individuals on cyproterone/spironolactone for androgen blockade, this needs to be monitored…
Serum electrolytes - potassium
We should consider ____ at baseline for those on feminizing hormones.
BMD testing
Masculinizing hormones involve the following…
Testosterone - SubQ or IM injection Q1-2 weeks
Could also use gel/patch forms
Note that in patients AFAB, ____ can still occur even while on masculinizing hormone therapy
Menstruation - can use progestin only birth control (Nexplanon!!)
Patients on masculinizing hormone therapy should be monitored…
Frequency?
Evaluate every 3 months in 1st year, then 1-2 times per year (or more if adjusting doses), monitoring for appropriate signs of virilization and adverse reactions
When on masculinizing hormones, serum testosterone should be monitored every…
3 months until levels are in the normal physiologic male range
For testosterone enanthate/cypionate injections, testosterone levels should be measured ____. The target level is…
Midway between injections. Target level = 13.9 to 24 nmol/dL
For transdermal testosterone, the level should be measured ____. Similar to other forms, the target level is…
No sooner than after 1 week of daily application. Target level = 13.9 to 24 nmol/dL
With masculinizing hormones, we should be monitoring the following labs…
Hematocrit/hemoglobin @ baseline, and every 3 months for 1st year, then 1-2x per year
Weight, blood pressure, and lipids at regular intervals
Screening for osteoporosis should be done for those who…
Related to testosterone therapy
Stop testosterone treatment, are inconsistent with hormone therapy, or develop risks for bone loss
Risks of masculinizing hormone therapy include…
This is just same risk when prescribing hormone to cisgender people
Increased CV risk, liver dysfunction
Mood
Polycythemia
Uterine bleeding, infertility, atrophy of genitals
REMEMBER THAT EVERYONE HAS HORMONES so these risks are… baseline
Risks of feminizing hormone therapy include…
This is just same risk when prescribing hormone to cisgender people
VTE risk, possible CV risk
Liver/kidney dysfunction
Lower libido, infertility
Mood
REMEMBER THAT EVERYONE HAS HORMONES so these risks are… baseline
