Lecture 13 - Gender Affirming Care

Question 1

Sex

Answer 1

What one is assigned at birth (XX, XY)

Question 2

Gender Identity

Answer 2

innermost concept of self as male, female, a blend of both, or neither

Question 3

Gender Expression

Answer 3

External appearance of one’s gender expressed through behavior, clothing, etc, to the world

Question 4

Sexual Orientation

Answer 4

Who you like, desire, are attracted to

Question 5

When writing a note after seeing a trans patient, what terms can you use?

Answer 5

Gender dysphoria - instead of gender identity disorder

ftm = famale to male 
mtf = male to female

Question 6

What are the two questions you ask a pt for gender identity?

Answer 6

What is your gender identity?

What sex were you assigned at birth?

then ask them “What are your pronouns?”

Question 7

Transwomen

Answer 7

male transitioning to female (mtf)

Question 8

Gender Dysphoria

Answer 8

DSM 5 criteria –doesn’t require a mental evaluation

2/6 for 6 months:
1. A marked incongruence between one’s experienced/expressed gender and
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics
primary and or secondary sex characteristics
because of a marked incongruence with one’s experienced/expressed gender
other gender
assigned at birth)
3. A strong desire for the primary and/or secondary sex characteristics of the
4. A strong desire to be of the other gender (or alternative gender than that
5. A strong desire to be treated as the other (alternative) gender
6. A strong conviction that one has the typical feelings and reactions of the other
(alternative) gender

Question 9

Non-binary pts

Answer 9

some pts may not conform to male or female binary gender identities, however, often these pts still meet diagnostic criteria for gender dysphoria and should be given gender affirming hormones if indicated

Question 10

6 key principles of trauma informed approach to care

Answer 10

safety 
trustworthiness and transparency 
peer support 
collaboration and mutuality 
empowerment, voice, and choice 
cultural, historical, and gender issues

Question 11

What are the permanent effects of testosterone hormone?

Answer 11

Increased facial and body hair growth
deepened voice
clitoral enlargement
male pattern baldness

Question 12

What are the reversible effects of testosterone hormone?

Answer 12

increased muscle mass and strength 
cessation of menstrual periods 
body fat redistribution 
skin oiliness 
vaginal atrophy (drying) 
increased libido

Question 13

Can you get pregnant even if you aren’t having a period?

Answer 13

Yes, because you still ovulate

consider IUDs in these transmale pts

Question 14

What are the side effects of testosterone hormone?

Answer 14

erythrocytosis/polycythemia –this is normal but just monitor to make sure H and H are in the male range

underlying autoimmune diseases can flair

migraines

creatine may increase

Question 15

What can occur if you inject too much testosterone?

Answer 15

aromatization into estrogen

Question 16

What are the permanent effects of Estrogen?

Answer 16

breast growth
decreased sperm production/maturation, reduced fertility
decreased testicular volume/size (‘likely’)

Question 17

What are the reversible effects of Estrogen?

Answer 17

thinning/slowed growth of body and facial hair
softening of skin/decreased oiliness 
body fat redistribution 
decreased muscle mass and strength 
decrease libido 
decreased spontaneous and/or morning erections 
Male sexual dysfunction 
cessation of male pattern balding