L13 - Transgender healthcare

Question 1

TRANSITION

i) name two things social gender role change involves
ii) what is hormone treatment used for?
iii) what % of hormone treatment is reversible? name two things that are less reversible
iv) name four departments that may be involved in the MDT approach at a gender identity clinic

Answer 1

i) change of name and clothes
ii) to supress biological sex hormone function
iii) 90% is reversible - harder to reverse breasts (trans man) and hair in a trans female
iv) psych support, speech and language therapy, endocrinology, surgery

Question 2

OESTROGEN TREATMENT FOR A TRANS FEMALE

i) what effect does it have on body and face hair? which does it affect more?
ii) does it affect already lost scalp hair?
iii) what cup size breasts should be expected?
iv) what approach to treatment gives optimal breast development? what happens if this does not happen?
v) after what time period is maximum effect achieved? do higher doses result in greater effect?

Answer 2

i) lessens facial hair (still req mechanical removal) and lessens body hair
- has more of an effect on body hair

ii) no effect on already lost scalp hair (it wont regrow)
iii) one size smaller than mothers

iv) gradual oes treatment for optimal breast dev
- if its given too fast get fusion of the breast buds & unwanted shape

v) 2 years to reach max effect
- higher doses do not result in a greater effect

Question 3

TYPES OF OESTROGEN TREATMENT

i) what is given oral/transdermally? why may it be used?
ii) what can be given to supress testosterone? how is this administered? under what condition would this not be necessary?
iii) what is the patient at increased risk of? what further increases this risk (2)
iv) how long does treatment need to be given for?

Answer 3

i) oestradiol
- higher doses than post meno HRT and safer than ethinylestradiol/conjugated equine oestrogens

ii) GnrH analogue
- given as an IM injection every three months
- not necessary after gonadectomy

iii) increased risk of venous thrombo embolism
- this is further increased by obesity and smoking

iv) treatment for life (dont stop at usual age of menopause)

Question 4

TESTOSTERONE TREATMENT FOR A TRANS MALE

i) what effects does it have on hair? (2)
ii) name two ways it can be administered? how often does each need to be given? which is the most common
iii) do you need a GnRH analogue? why?
iv) what is the patient at risk of? why? what should therefore be monitored? what increases the risk of this?
v) when is the maximum effect of treatment acheived? do higher doses increase effects?

Answer 4

i) male pattern hair growth (less reversible) and male pattern baldness
ii) can be given IM injection 3 monthly (most common) or transdermal gel (daily)
iii) no - because testosterone will inhibit oes production

iv) risk of polycythaemia as testosterone can stim RBC produc
- monitor Hb and haematocrit
- increase risk in smokers

v) max effect achieved after 5 years and higher doses do not speed this up

Question 5

SEXUAL HEALTH AND CONTRACEPTION

i) what two methods may be considered if a trans male is having sex with men?
ii) what can testosterone treatment cause in relation to contraception?
iii) which group has a relatively higher HIV prevalence?

Answer 5

i) IUD or progesterone
ii) testosterone can be teratogenic
iii) trans females have higher hiv prevalence

Question 6

SCREENING

i) are trans individuals automatically called for screening?
ii) what screen may a trans female be called for from age 50? how long do they have to be on hormone therapy for?
iii) what may both trans males and females be called for at 60? what would make this happen sooner (2)
iv) which two screening methods should be used for trans males? when may this not be relevant?
v) what should be considered 2 yearly for trans men? why?

Answer 6

i) no

ii) mammography
- once on hormone therapy for five years

iii) at 60 called for a DEXA scan
- sooner if there are RF for osteoporosis or if there has been inadequate hormone therapy post gonadectomy

iv) cervical and breast screening unless surgically removed

v) consider US of the endometrium every two years = risk of hyperplasia
- dont need if surgically removed

Question 7

PSYCHOLOGICAL CARE

i) which four things are trans individuals at increased risk of?
ii) what may be helpful for them to attend?

Answer 7

i) depression, suicide, self harm and substance abuse
ii) self help groups as social isolation is often a problem

Question 8

SUB SPECIALIST AREAS

i) in adolescents - what can be given to delay puberty?
ii) what is required in decisions about puberty delaying drugs and subsequent hormone therapy in adolescents?
iii) a combinations of what help may be needed for non binary individuals
iv) is there an evidence base for hormone therapy in non binary individuals? what may be another treatment option?

Answer 8

i) GnRH analogues
ii) MDT approach
iii) combo of psycholgical approach and MDT

iv) no
- can give lose dose/short term therapy

Question 9

LONG TERM HEALTH OUTCOMES

i) give three beneficial effects of treatment
ii) higher levels of what two things occur in this population?
iii) do trans females or males have more deaths from CVD, VTE, lung cancer, HIV? what increases this risk?

Answer 9

i) reduced psychopathology eg depression and anxiety, improved sexual and social functioning
ii) higher levels of suicide and self harm

iii) trans females more at risk of death from various diseases
- this increases if they are a smoker