Hormone Therapy

Question 1

Feminizing Hormone Therapy Permanent changes

Answer 1

Breast growth

Question 2

Feminizing Hormone Therapy Possibly permanent changes

Answer 2

infertility, decreased sperm production; decreased testicular size; penile atrophy; fat redistribution

Question 3

Feminizing hormone therapy Possibly reversible changes

Answer 3

Decreased libido; muscular atrophy; decreased strength; loss of erections and male sexual function; less acne; softer skin; less body hair growth; slowing of male pattern baldness; decreased RBC’s to cisfemale ranges

Question 4

Feminizing hormone therapy possible risks

Answer 4

venous thromboembolism; weight gain; gallstones; changes in cholesterol; increased BP

Question 5

How can people minimize the risks of hormone therapy

Answer 5

maintaining a healthy weight, exercising, not smoking, eating a healthy diet

Question 6

Oral estradiol feminizing doses

Answer 6

2-8mg daily; bid or tid

Question 7

sublingual estradiol doses

Answer 7

2-8mg daily, bid or tid

Question 8

estradiol patch dose

Answer 8

0.1-0.2 mg 2x per week

Question 9

estradiol injection dose

Answer 9

8-10 mg weekly, can be divided into biweekly injections

Question 10

androgen blockers: spironolactone dose

Answer 10

50-100mg daily

Question 11

androgen blockers finasteride dose

Answer 11

2.5-5mg daily

Question 12

Feminizing lab work

Answer 12

year 1- total testosterone and estradiol labs every 3 months
year 2+-total testosterone and estradiol labs every 6-12 months
years CBC, CMP, Lipids, other prn labs

Question 13

Estradiol lab ranges

Answer 13

40-600pg/mL (cisfemale range)

Question 14

Testosterone labs

Answer 14

10-50ng/dL (cisfemale range)

Question 15

Absolute contraindications for feminizing therapy

Answer 15

inability to give informed consent

Question 16

Relative contraindications to feminizing therapy

Answer 16

personal hx of breast cancer, personal hx of thromboembolism, severe, untreated psychiatric conditions

Question 17

masculinizing changes that are likely permanent

Answer 17

deepening voice, clitoral enlargement, body hair growth, male pattern baldness

Question 18

Masculinizing changes that are likely reversible

Answer 18

increased muscle mass; decreased fat in buttocks, hips, thighs; increase fat in abdomen; increased sex drive; amenorrhea; vaginal atrophy; acne

Question 19

Masculinizing possible risks

Answer 19

polycythemia, weight gain, sleep apnea, elevated liver enzymes, increased cholesterol, increase in BP, destabilization or worsening of severe psychiatric disorders (schizophrenia and bipolar disorder), heart disease

Question 20

Testosterone SQ/IM dose

Answer 20

50-100mg every week

Question 21

Testosterone gel 1%

Answer 21

25-50mg daily

Question 22

Testosterone patches (4mg/24 hours)

Answer 22

1 patch daily

Question 23

Masculinizing labs

Answer 23

year 1 = total testosterone every 3 months
year 2+ =total testosterone every 6-12 months
yearly= CBC, CMP, lipids, other labs prn

Question 24

Total testosterone labs

Answer 24

300-900ng/dL (cismale range)

Question 25

Absolute contraindications to masculinizing therapy

Answer 25

inability to give informed consent

Question 26

relative contraindications to masculinizing therapy

Answer 26

severe liver disease; severe, untreated psychiatric condition

Question 27

DSM V Definition

Answer 27

Incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months, and manifested by at least 2 of the following:
incongruence between expressed gender and primary/secondary sex characteristics
strong desire to be rid of one’s primary/secondary sex characteristics
a strong desire for the primary/secondary sex characteristics of the other gender
a strong desire to be the other gender
a strong desire to be treated as the other gender
a strong conviction that one has the typical feelings and reactions of the other gender

Question 28

Possible causes of gender dysphoria

Answer 28

**Strong link to genetics
chromosomal variations (klinefelter syndrome xxy; de la chapelle syndrome xx with SRY mutations)
DES exposure in utero,
aromatase excess syndrome (excess estrogen)
androgen insensitivity syndrome (body cannot use testosterone)
PCOS
ASD
neuroanatomical variations
embryogenesis variations

Question 29

Goals of GAHT

Answer 29

feminize or masculinize the body, reduce depression/anxiety, provide bodily autonomy

Question 30

What is the informed consent model?

Answer 30

allows individuals to make informed decisions about their body, review possible risks of being on hormones, review temporary and permanent changes one can expect while on hormones, evaluate a patient’s ability to give informed consent (mental health, substance abuse)