Lecture 3 - Trans

Question 1

Puberty Blockade med used

Answer 1

Gonadotropin Releasing Hormone Agonists

Question 2

GnRH agonist MOA

Answer 2

suppress body release of sex hormones, inc test and estrogen

GnRH causes constant stim vs pulses (which occur naturally)
Pituitary becomes less sensitive to GnRH and stops releasing FSH/LH
Gonads stop releasing sex hormones

Puberty resume if GnRH agonist is D/c, effects reversible

Question 3

Criteria to start GnRH Agonists

Answer 3

Reached Tanner Stage 2 (start puberty)
Gender diversity marked and sustained over time
Receive comprehensive eval by med/mental profesionals
Ability to provide informed consent
discussion of potential loss of fertility and fertility preservation options

Question 4

GnRH agonist meds

Answer 4

Histrelin implant = last 12 months, placed surgically in arm
Leuprolide IM injec = Every month/3months depend on dosage

Question 5

GnRH agonist AE

Answer 5

Lower bone mineral density, take cal/vit D
Fertility = harder or impossible to have kids

Question 6

Most common anti-androgen for Feminizing Hormone Therapy

Answer 6

Spironolactone

Dose for suppression = ~ 100 - 400mg/day

oral tab, inexpensive

monitor K+

Question 7

Spironolactone info

Answer 7

using it an reduce dose of estradiol

chop balls off and dont need anymore

Question 8

Which Estrogen should be used for Feminizing Hormone Therapy

Answer 8

Ethinyl Estradiol = VTE, used for Birth control
Conjugated estrogens = difficult prevent supra physiologic dosing

Question 9

Which Estrogen Formulation is preferred

Answer 9

Estradiol (17B-estradiol)

Question 10

Estradiol Tablet info

Answer 10

2-6mg QD, least expensive and easiest to dose

Question 11

Estradiol patch info

Answer 11

patch 0.025-0.2mg/day

Lowest VTE risk, rec for pts >45 and w/ previous VTE

Question 12

Estradiol IM injection info

Answer 12

Peak and trough effects can be emotionally distressing

additional supplies req

Question 13

Estradiol Feminization effects

Answer 13

Body fat redistribution
Breast growth
Softening skin/ dec oilness

Dec random boners
Dec muscle mass/strength
Dec ball sizes n sperm production
Thinning and slowed growth of body hair

Take take months to years

Question 14

SE of Estradiol

Answer 14

Migrines
weight gain
VTE = biggest risk
Elevated LFT
gallstones/pancreatitis

penis broken and dec libido

Question 15

Masculizing Hormone Therapy usual therapy?

Answer 15

Testosterone therapy

Question 16

Testosterone Formulations

Answer 16

injectable
transdermal
oral

Question 17

Test Injectable info

Answer 17

Q1-2weeks

Cypionate, Enanthate, Propionate

have peak and trough

Question 18

Test transdermal info

Answer 18

Patch & gel

have more steady levels

Question 19

Test Oral info

Answer 19

no current rec for GAHT
maybe used ppl who cant tolerate other routes

Question 20

test inject admin info

Answer 20

draw up needle = 18-20 gauge

22-23 gauge for IM
25-27 gauge for Subq

Question 21

Test Masculization effects

Answer 21

inc facial and body hair
inc muscle mass and strenght
deepened voice
body fat redistribution

Loss of menses

takes years to develope

Question 22

SE of Test

Answer 22

Polycythemia
Weight gain
Mood lability
inc sex drive
inc skin oilness/acne
scalp hair loss

girl specific effects = clit bigger, infertility, vag atrophy