LGBT Flashcards
1
Q
Sex vs Gender
A
- Sex: assigned based on external genitalia
- Gender: assigned based on an internal sense of self and how one fits into society
- Gender non-binary: doesn’t fit as male or female, on spectrum
2
Q
Queer
A
- Term used to express fluid identities and orientations
- May have a negative connotation for some LGBT members
3
Q
Health Disparities in LGBT
A
- Higher rates of depression/anxiety/suicide
- Higher rates of homelessness
- Higher rates of violence victimization
- Lower rates of mammography and Pap smear
- Higher rates of smoking/substance abuse
- Higher rates if HIV and other sexually transmitted diseases
- Higher rates of unhealthy weight control/perception
4
Q
Goals of LGBT Awareness/Competency
A
- Improve healthcare to LGBT patients
- Decrease LGBT health disparities
- Improve outreach/education on health risks of LGBT people
- Create an LGBT affirming environment for healthcare professionals and patients
5
Q
Implicit/Privilege
A
- Implicit: individual feeling that we are unaware of or mistaken about their nature (own personal preferences/aversions)
- Implicit bias: out attitude towards people and associated stereotypes with them without conscious knowledge
- Privilege: advantages granted to a particular person or group
6
Q
Gender Pronouns
A
- Make sure patient is still using pronouns that you have listed periodically
- Some identify as a gender but aren’t ready to use the pronouns for that gender yet
- EMR/systems of care can help to determine sex assigned at birth and affirmed gender
7
Q
Informed Consent Model
A
- Review: Gender history and experience, collaborate with behavioral health
- Set Goals: gender goals, will HT meet the goals, greater dysphoria?
- Consent: obtain consent
- Assess: Safety concerns, housing, work, transportation
- Monitor: order screening labs, hormones, CBC, fasting lipids, LFTs, STI, HIV, etc.
8
Q
Treatments for Gender Dysphoria
A
- Social transition
- Psychotherapy
- Pharmacologic therapy
- Surgery: gender confirmation
- Voice training
- Electrolysis
9
Q
Individualizing Treatment
A
- Degree of transition: binary female, androgynous, feminine spectrum
- Erections: eliminate or maintain
- Surgery: Some patients may take hormones to prepare for surgery while others may not want surgery at all
10
Q
Feminizing Hormone Therapy
A
- General approach: estrogen (preferably beta-estradiol) with anti androgen
- Anti-androgen: spironolactone or GnRH analog
- Spironolactone inhibits testosterone synthesis and androgen binding to receptor (higher than CV disease)
- GnRH analog: block GnRH receptor to stop follicle stimulating hormone and luteinizing hormone
- Aim: 100-200 pg/mL for estrogen, <55 ng/dL for testosterone
11
Q
Estrogen SE
A
- Hot flashes
- Mood swings
- Migraines
- Weight gain
- VTE: oral ethinyl estradiol
- HyperTGA
12
Q
Reducing VTE Risk
A
- Use 17-beta estradiol (preferably patches)
- Avoid first pass metabolism and tobacco use
- Avoid combination of progesterone with estrogen
- Do not exceed estrogen levels above physiologic range of cis-females
- Low dose aspirin?
13
Q
Estradiol CI
A
- VTE related to underlying hypercoagulable state
- Estrogen sensitive neoplasm
- End-stage liver disease
- Informed consent process should be done with patients with these risk factors
14
Q
Masculinizing Hormone Therapy
A
- Goals: develop male secondary sex characteristics, suppress/minimize female secondary characteristics
- General approach: Testosterone monotherapy
- Goal levels: 400-700ng/dL between injections
15
Q
SE/CI of Testosterone
A
- Polycythemia: transdermal has less
- Weight gain
- Mood lability
- Increased sex drive
- Infertility
- Lower HDL and elevated TGA
- CI: Pregnancy
