Lecture 57

Question 1

gender-affirming care

Answer 1

address social, mental, and medical health needs and well-being
supports gender diverse people across the lifespan
holistic and multidisciplinary
family medicine, primary care, endocrinology, reproductive health, sexual health, mental health, voice and communication, preventive care, chronic disease management, surgery
inclusive and non judgemental

Question 2

evidence based treatment guidelines

Answer 2

endocrine society – endocrine treatment of gender-dysphoric/gender-incongruent persons; an endocrine society clinical practice
fenway health – medical care of trans and gender diverse adults
UCSF transgender care – guidelines for the primary and gender-affirming care of transgender and gender nonbinary people
WPATH – standards of care for the health of transgender and gender diverse people, version 8

Question 3

testosterone type

Answer 3

cypionate injection (cottonseed oil) or enanthate injection (sesame seed oil)
topical gel packets or pump formulation
patch

Question 3

baseline lab monitoring

Answer 3

basic or complete metabolic profile
complete blood count
hepatitis A,B,C
HIV

Question 4

SE of testosterone

Answer 4

migraine headache
hair loss
PCOS
acne
screen for osteoporosis and risk of bone loss
medical risk – CAD, cerebrovascular disease, HTN, breast/uterine cancer

Question 5

monitoring of testosterone

Answer 5

CBC for hemoglobin/hematocritc (erythropoietic effects)
lipid profile
LFT (risk of AST/ALT greater than 3 times the upper limit)
fasting glucose/HgbA1c
serum testosterone
sex hormone binding globulin/albumin (calculated free testosterone levels)
estradiol (pelvic pain and persistent menses)

Question 6

estradiol types

Answer 6

valerate injection (sesame/castor oil) and estradiol injection (cottonseed oil)
patch
tablet

Question 7

estradiol SE

Answer 7

hyperprolactinemia and galactorrhea (monitor prolactin if symptomatic, have new onset headaches, and taking other meds that increase prolactin)
weight gain
VTE risk
migraine (prefer oral/patch form)
screen for osteoporosis and bone loss risk
medical risks – breast cancer, CAD, cholelithiasis

Question 8

anti-androgen types

Answer 8

spironolactone (suppress testosterone synthesis)
finasteride/dutasteride (if spironolactone not tolerated)
bicalutamide (for liver function abnormalities)

Question 9

spironolactone SE

Answer 9

reduce breast development due to estrogen receptor activity (use only estradiol as a result)
orthostasis and polyuria can occur (so take in the morning)

Question 10

Finasteride/dutasteride SE

Answer 10

decreased libido
erectile dysfunction (may be desired)

Question 11

monitoring for anti-androgens (same for estradiol)

Answer 11

renal function
potassium if on spironolactone
lipid profile
HgbA1c/fasting glucose
Estradiol

Question 12

types of progesterone

Answer 12

bioidentical micronized progesterone (oral capsule)
medroxyprogesterone
anecdotal improved breast/areolar development

Question 13

transgender women medications

Answer 13

progesterone
anti-androgens
estradiol

Question 14

1-6 month onset timeline for transgender men

Answer 14

skin oiliness/acne
fat redistribution (max 2-5y)
cessation of menses
clitoral enlargement
vaginal atrophy
all have a max of 1-2 years

Question 15

6-12 month onset timeline for transgender men

Answer 15

facial/body hair growth (max 4-5 y)
scalp hair loss (treat)
increased muscle mass/strength (max 2-5y)
deepening of voice (max 1-2y)

Question 16

1-3 month onset for transgender women

Answer 16

decreased sexual desire
decreased spontaneous erections
max of 3-6y

Question 17

2-6 months onset for transgender women

Answer 17

breast growth and decreased testicular volume
max 2-3y

Question 18

3-6 month onset for transgender women

Answer 18

redistribution of body fat (max 2-3y)
decrease in muscle mass and strength (max 1-2y)
softening of skin/decrease oiliness (unknown)

Question 19

other onset timeline for transgender women

Answer 19

variable –> male sexual dysfunction (max variable)
unknown –> decreased sperm production (over 3y)
6-12 months –> decreased terminal growth (over 3y)
no onset –> voice changes

Question 20

syringe and needle requirements

Answer 20

disposable syringe and two needles for each injection
1mL syringe, 18/20 gauge needle, 22-26 gauge needle

Question 21

reason for 1mL syringe

Answer 21

necessary
due to small volume and need for accuracy

Question 22

second needle for IM injection

Answer 22

22/23g with a 1inch or 1.5inch needle

Question 23

second needle for SQ injection

Answer 23

25/25g with a 5/8 inch needle