Gender Affirming Care

Question 1

Being transgender simply means…

Answer 1

When someone’s gender identity is different than their sex assigned at birth

Question 2

Cisgender simply refers to…

Answer 2

When a person’s gender identity matches their sex assigned at birth

Question 3

Gender dysphoria refers to…

Answer 3

The incongruence between experienced/expressed gender, and assigned gender

Question 4

Gender euphoria refers to…

Answer 4

Satisfaction and joy caused by congruence between one’s gender identity and their features, expression, or experiences

Question 5

Puberty blockers MOA is to…

Answer 5

Pause/slow the effects of puberty - prevent changes such as voice lowering, breast growth, and periods

Question 6

Effects of puberty blockers will vary, depending on…

Answer 6

How far puberty has progressed before starting the blocker

Question 7

If puberty blockers are stopped…

Answer 7

Puberty will begin again - EFFECTS ARE REVERSIBLE

BUT if youth begins hormone therapy, they will experience puberty related changes associated with hormone prescribed

Question 8

Common reasons why puberty blockers are prescribed include…

Answer 8

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

Question 9

Most common puberty blocker is…

Answer 9

Leuprolide (Lupron)

Question 10

In someone who is assigned male at birth, a puberty blocker will stop/limit…

Answer 10

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

Question 11

In someone who is assigned female at birth, puberty blockers will stop/limit…

Answer 11

Breast tissue development
Broadening of the hips
Monthly bleeding

Question 12

In both AFAB and AMAB cases, puberty blockers will temporarily stop/limit…

Answer 12

Growth in height, and accumulation of calcium in the bones
Development of sex drive
Fertility
Strong emotions of adolescence

Question 13

Risks associated with prescribing blockers…

Answer 13

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

Question 14

Risks associated with withholding blockers may include…

Answer 14

Distress
Dysphoria
Anxiety
Depression
Suicidality

Question 15

Feminizing hormones involve the following…

Answer 15

Daily estradiol and androgen blocker (if testes are present)

Question 16

Time for effect from feminizing hormones can take up to…

Answer 16

5 years

Question 17

A patient on feminizing hormones should be monitored this frequently…

Answer 17

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

Question 18

While on feminizing hormones, midcycle serum testosterone and estradiol should be measured…

Answer 18

Every 3 months

Question 19

While on feminizing hormones, serum testosterone should be…

Answer 19

Less than 1.74 nmol/L

Question 20

While on feminizing hormones, serum estradiol should not exceed…

Answer 20

Peak physiologic range of 367-734 pmol/L

Question 21

For individuals on cyproterone/spironolactone for androgen blockade, this needs to be monitored…

Answer 21

Serum electrolytes - potassium

Question 22

We should consider ____ at baseline for those on feminizing hormones.

Answer 22

BMD testing

Question 23

Masculinizing hormones involve the following…

Answer 23

Testosterone - SubQ or IM injection Q1-2 weeks
Could also use gel/patch forms

Question 24

Note that in patients AFAB, ____ can still occur even while on masculinizing hormone therapy

Answer 24

Menstruation - can use progestin only birth control (Nexplanon!!)

Question 25

Patients on masculinizing hormone therapy should be monitored... | Frequency?

Answer 25

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

Question 26

When on masculinizing hormones, serum testosterone should be monitored every...

Answer 26

3 months until levels are in the normal physiologic male range

Question 27

For testosterone enanthate/cypionate injections, testosterone levels should be measured ____. The target level is...

Answer 27

Midway between injections. Target level = 13.9 to 24 nmol/dL

Question 28

For transdermal testosterone, the level should be measured ____. Similar to other forms, the target level is...

Answer 28

No sooner than after 1 week of daily application. Target level = 13.9 to 24 nmol/dL

Question 29

With masculinizing hormones, we should be monitoring the following labs...

Answer 29

Hematocrit/hemoglobin @ baseline, and every 3 months for 1st year, then 1-2x per year Weight, blood pressure, and lipids at regular intervals

Question 30

Screening for osteoporosis should be done for those who... | Related to testosterone therapy

Answer 30

Stop testosterone treatment, are inconsistent with hormone therapy, or develop risks for bone loss

Question 31

Risks of masculinizing hormone therapy include... ## Footnote This is just same risk when prescribing hormone to cisgender people

Answer 31

Increased CV risk, liver dysfunction Mood Polycythemia Uterine bleeding, infertility, atrophy of genitals ## Footnote REMEMBER THAT EVERYONE HAS HORMONES so these risks are... baseline

Question 32

Risks of feminizing hormone therapy include... ## Footnote This is just same risk when prescribing hormone to cisgender people

Answer 32

VTE risk, possible CV risk Liver/kidney dysfunction Lower libido, infertility Mood ## Footnote REMEMBER THAT EVERYONE HAS HORMONES so these risks are... baseline