Gender/Sexual minority

Question 1

trans meds

Estradiol Effects

Answer 1

Effect: body fat redistribution, decrease muscle mass, slowed facial/body hair growth, decreased testicular volume, decreased libido, decreased spontaneous erections, decreased sperm production, breast growth

Question 2

Trans meds

Spironolactone

effects

Answer 2

Effect: decreased body hair growth

Question 3

Estradiol

Risks and goals

Answer 3

Risks: venous thromboembolic disease, increase gallstones, weight gain, HTN, DM, Cardiac risk

Goals: serum T < 50ng/dL; serum estradiol < 200ng/mL

Question 4

spirolactone

risks

Answer 4

Risks: hyperkalemia, hypotension/dizziness, hyponatremia

Question 5

Monitoring patients Receiving Feminine Hormone Treatment

Answer 5

Question 6

Hormone therapy

Testosterone effects

Answer 6

Effects: deepened voice, clitoral enlargement, increase facial/body hair, cessation of menses, atrophy of breast tissue, increased libido, decrease body fat: muscle mass ratio

Question 7

testosterone

Risks and dose goals

Answer 7

Risks: polycythemia, weight gain, acne, androgenic alopecia, sleep apnea, increase LFTs, increase lipids; increase DM, HTN, CVD

Goals: serum T 300-1,000ng/dL

Question 8

Monitoring patients Receiving Masculinizing Hormone Treatment

Answer 8

Question 9

Special considerations for Exam in Trans patients

Answer 9

Binding of chest can lead to skin breakdown

Tucking of testicles and penis may lead to hernias or skin complications

Transgender patients are more likely to find an examination of genitalia traumatic

Discuss procedure and indication beforehand and allow the patient to express concerns

Consider
anatomy will be different if on HT
Administration of vaginal estrogens 1-2 weeks prior to speculum exam to decrease vaginal atrophy associated with testosterone therapy
Use smallest speculum size available and consider use of anoscope

Question 10

Considerations in Care of TransMALE

Answer 10

Screening mammograms should be performed in AFAB with breast as per USPTF guidelines

PAP smears in AFAB patients should be performed as per USPTF
Consider pediatric speculum or anoscope
Administration of vaginal estrogens 1-2 weeks prior to speculum exam to decrease vaginal atrophy associated with testosterone therapy
Can try to palpate cervix first to minimize manipulation of speculum
Move buttocks past the end of the table
Consider self-collected samples

Acne assoc with Testosterone therapy usually peaks and declines after 1 year
DEXA scans at age 65; if had oophorectomy before 45 consider earlier DEXA
If had mastectomy should still perform annual exam of any remaining breast tissue and axillary lymph nodes

Question 11

Consideration in Care of TransWOMAN

Answer 11

Annual breast exam age > 50 or estrogen > 5 years

PSA monitoring per USPTF guidelines in AMAB
If present with UTI symptoms, depending on anatomy, consider they may have prostatitis

If had gonadectomy can usually stop feminizing HRT ( estrogen/spiro) at age 50

Can use sildenafil and Cialis to aid with low libido or ED

Sex hormone-sensitive cancer requires consultation with oncology and is likely contraindication to HRT

Hair loss can be treated with minoxidil or 5-alpha reductase inhibitor (finasteride)

DEXA scan at 65

If on HRT ( estrogens) > 5 year or > age 50 screening mammogram every 2 years

If on estrogen should have annual prolactin level and visual field examination to screen for prolactinoma

Question 12

Care of genderqueer, gender non-conforming, and gender nonbinary Patient

Answer 12

Discuss goals

Access risks
What are you doing to prevent STI
What are you doing to prevent pregnancy
Do you receive penetrative anal sex

Discuss family planning

Multitude of therapies depending on their goals

Preventative screening determined by assigned sex at birth