LGBT Health

Question 1

disparities that affect the LGBT population

Answer 1

*higher prevalence of STIs/HIV
*high rates of victimization and discrimination
*higher rates of homelessness & unemployment
*higher rates of suicide attempts & mental health issues
*less likely to have health insurance
*more likely to delay seeking care
*higher rates of tobacco, alcohol, and drug use

Question 2

LBGT health: the interview & exam

Answer 2

*preferred pronoun + preferred name = gender affirmation
*initial visit:
-engage patients in comprehensive primary care system
-collect baseline medical information
-examine body parts that pertain to visit, use patient’s preferred terminology
-begin hormone therapy assessment

Question 3

LBGT health: the interview - intake

Answer 3

*have a transgender health resources packet
*complete medical history
*assess health care maintenance/update as needed
*mental health history
*social history
*medication history
*labs

Question 4

LBGT health: requirements for initiating hormones

Answer 4

to start hormone therapy, WPATH (world professional association for transgender health) recommends either:
1. a referral letter from a mental health professional
OR
2. doctor to make diagnosis of gender dysphoria (DSM5) and evaluate capacity to provide informed consent

Question 5

gender dysphoria - DSM5 criteria

Answer 5

*involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning
*must last at least 6 months and show at least 2 criteria

Question 6

LBGT health: risks of feminizing hormones

Answer 6

*venous thromboembolic disease
*gallstones
*elevated liver enzymes
*weight gain
*hypertriglyceridemia
*hypertension
*T2DM

note - no increased risk or inconclusive risk of breast cancer

Question 7

LBGT health: risks of masculinizing hormones

Answer 7

*polycythemia
*weight gain
*acne
*hyperlipidemia
*CVD/HTN/T2DM

note - no increased risk or inconclusive risk of cancers

Question 8

LBGT health: time expectations of initiating hormones

Answer 8

*usually recommend that patients give it about a year before expecting to see significant changes

Question 9

feminizing hormones - overview

Answer 9

*upon initiation, prescribe estrogen + an androgen blocker
*many different forms of both (usually starts with an estrogen transdermal patch)
*progesterone use is controversial

Question 10

feminizing hormones - important labs to check

Answer 10

*BUN/Cr/K+
*lipids
*A1c or glucose
*estradiol
*total testosterone
*sex hormone binding globulin
*albumin
*prolactin

Question 11

masculinizing hormones - overview

Answer 11

*upon initiation, start testosterone
*IM or SQ option
*can start lover if patient desires

Question 12

masculinizing hormones - important labs to check

Answer 12

*lipids
*A1c or glucose
*total testosterone
*sex hormone binding globulin
*albumin
*Hb & Hct

Question 13

LGBT health: cancer screening

Answer 13

*screen the organ that is present

1. transmen:
   -cervical cancer screening
   -mammogram (if no surgery)
2. transwomen:
   -prostate cancer (PSA can be falsely lower)
   -mammogram (if 50+ or at least 5-10 years on hormones)

Question 14

LGBT health: bone health

Answer 14

*not great data on transwomen or men regarding osteoporosis risk
*screening:
-ALL transpeople should begin bone density screening at age 65
-between 50 to 64 if risk factors for osteoporosis
-if gonadectomy without HRT for 5+ years, then test regardless of age