Lecture 29: An endocrine perspective on gender dysphoria and changing gender Flashcards
How does puberty develop in girls?
Ovaries make estradiol startinga bout 10y
- thelarche, growth acceleration, pelvic widening, wfat redistribution
- uterus develops and by 2 years at 12y, menarche
- by 14, growth is finished and meses are regular and ovulatory, providing most of young woman’s testosterone
How does puberty develop in boys?
Testes grow and testosterone starts at 12
What are the three types of changes for individuals with gender dysphoria?
- social change
- hormonal change
- anatomic change
How do you facilitate hormonal sex change?
Step 1: Blocking endogenous puberty
Step 2: Replacing desired sex hormones
How do you block endogenous puberty?
Use a GnRH analog like Leuprolide (Lupron) and Histrelin (supprelin)
Binds to GnRH receptors of pituitary gonadotrope cells and shuts them off
Can be reversible
May impair bone density, but can be used in individuals who start puberty too early
How do you replace desired sex hormones?
Testosterone by monthly IM injection Estradiol by skin patches 1-2x/week Gradually increasing dosing Not reversible if you stop treatment.. Can stop Lubron/Supprelin Lifelong treatment
What is Lupron?
Leuprolide
A GnRH analog that shuts off puberty
What is Supprelin?
Histrelin
A GnRH analog that shuts off puberty
How permanent are the hormonal body changes?
Delaying puberty for a few years has no known lasting effect except reduced bone mass
We have anecdoctal evidence of residual fertility in at least some adults with history of prolonged sex hormone suppression, but no idea of magnitude of fertility reduction
What is the idealized pathway in transsexual history?
- diagnostic assessment
- counseling
- real life experience
- hormone suppression/replacement
- surgery
What is the Kartagener syndrome?
Primary ciliary dyskinesia
Autosomal recessive genetic disorder
Defect in cilia in respiratory, fallopian tube and flagella in sperm
