Gender Care

Question 1

Gender-affirming care

Answer 1

-addresses social, mental, medical health needs and well-being
-supports gender diverse people across the lifespan
-holistic and multidisciplinary
-fam medicine, PCP, lots of things
-inclusive nonjugmental

Question 2

Diagnostic criteria for gender dysphoria

Answer 2

-diff between expierienced gender and sex assigned at birth
-sex characteristics cause dysphoria
-desire/preference to live as other gender
-associated w clinically significant distress in ADL

Question 3

Why do we diagnose gender dysphoria

Answer 3

-billing for care
-not everyone who identifies as trans has gender dysphoria
-identifies mood symptoms related to person’s body and experience of world
-identifying as trans or nonbinary is NOT a disorder

Question 4

Goal of Gender-affirming hormone therapy (GAHT)

Answer 4

-suppress endogenous sex hormone secretion setermined by the person’s genetic sex
-maintain sex hormone levels within nomal range for affirmed gender

Question 5

Fertility preservation in trans men

Answer 5

-testosterone
-possible loss of fertility
-may desire to harvest and bank eggs before treatment
-use contraception

Question 6

Fertility preservation in trans women

Answer 6

-estradiol dec sperm
-may desire to bank sperm before treatment

Question 7

Baseline lab monitoring for all patients

Answer 7

-basic/complete metabolic profile
-complete blood count
-Hep A, B, C vax
-HIV

Question 8

Testosterone fo trans men

Answer 8

-cypionate injection (cottonseed)
-enanthate injection (seasame)
-topical gel dry at least 2 hours no skin contact
-patch

Question 9

testosterone dose adjustment

Answer 9

-based on effects and cessation of menses

Question 10

Testosterone side effects

Answer 10

-migraine
-hair loss (treat w finasteride or dutasteride)
-PCOS
-acne
-screen osteoporosis
-CV diseases
-cancer

Question 11

Testosterone lab monitoring

Answer 11

-CBC
-lipids
-livere test
-fasting glucose
-serum testosterone
-sex hormone binding globulin
-estradiol

Question 12

17-B-Estradiol

Answer 12

-valerate injection (seasame or castor) and estradiol injection (cottonseed)
-patch preffered if pt smoke or high VTE risk
-tablet

Question 13

Estradiol side effects

Answer 13

-hypoerprolactinemia
-galactorrhea
-weight gain
-VTE risk
-migraine titrate slowly
-screen osteoporosis risk
-breat cancer CAD

Question 14

Anti-androgens for trans women

Answer 14

-minimize secondary characteristics
-spironolactone
-finasteride or dutasteride
-bicalutamide but concern for liver

Question 15

Spirinolactone side effects

Answer 15

-may reduce breast development
-pt can use estradiol only and add spironolactone only
-orthostasis and polyuria (take in am to dec pissing at night)

Question 16

Finasteride/dutasteride side effects

Answer 16

-dec libido
-ED

Question 17

Progesterone for trans women

Answer 17

-micronized (peanut allergy)
-medroxy oral id prefered and not allergenic
-pt might want it for breast development but little studies

Question 18

Estradiol and spirinolactone lab monitoring

Answer 18

-renal function
-potassium on spirinolactone
-lipid profile
-HgbA1c/fasting glucose
-estradiol

Question 19

Injection needle requirements

Answer 19

-disposable syringe and 2 needles/inj
-1mL syringe
-large gauge (18-20)
-switch to smaller gauge after inj drawn up
-22-23g, 1-1.5 inc for IM
-25-26g, 5/8 in for SQ

Question 20

Considerations for trans health care in adults

Answer 20

-improve depression symptoms
-need to know use of non-prescribed hormone use and other drug therapies
-insurance sucks

Question 21

Gender-affirming care in youth

Answer 21

-GnRH agonists and mense suppression
-irreversible hormone therapies not considered until at least 16 for youths in care for years