LGBTQIA+ Health Flashcards
Intersectionality
Having more than one social identity creates a whole
I.E: trans person of color vs cis person of color
Implicit bias
What to do if you have them?
Having an opinion or stereotype about a person or group of people without realizing it
Be aware of your own and reflect on them
Informed consent vs Standards of Care
Informed: patient decides what type of care is appropriate
Standards of care: mental health provider decides what tpye of care is appropriate
What to consider before starting hormone therapy for transitioning
- Think about the patient’s goals of treatment
- Research costs w/ and w/o insurance
- Don’t put off starting hormone therapy until other illnesses are under control
- Very few absolute contraindications to starting hormone therapy, only if the condition is extrememly unstable for the patient
- I.E: HIGH LFTs, breast cancer (estrogen therapy)
- Gender history: what hads it been like for you to think about your gender/gender identity?
- Managing expectations - BE REALISTIC
- Go over expected timeline/changes
- what hormones don’t do
- Does the patient have support?
Irreversible changes (testosterone therapy)
- Clitoris grows
- Body hair becomes darker and thicker
- Voice deepens
- Facial hair grows
- Head hair becomes thinner
- “Male pattern baldness”
Reversible changes (testosterone therapy)
- Body fat redistibutes - abd + waist
- Muscle mass increases
- Acne increases
- Skin becomes oiler
- Libido increases
- Menstruation stops 6 months in
- bleeding can get irregular or unusual when starting T
Three BIGGER things that testosterone DOES NOT DO
- Increase height (if puberty is complete)
- Shrink breasts
- Change vocal intonation - pronunciation (can practice changing)
- Change bone structure
Testosterone therapy risks
- Heme: Erythrocytosis → clot risk
- GI: liver inflammation → only check LFTs if have s/s
- CV: teach lifestyle modifications to decrease risk
- HTN, HLD, MI, stroke
- Endocrine: only check for insulin resistance if need to
- Reproductive: infertility, vaginal dryness/atrophy
- Psychosocial
- Destabilization of certain mood disorders: bipolar + schizophrenia losing stability when starting T → dose daily instead of weekly
- Social consequences: transphobic society
Causes of pelvic pain in transmasculine patients
- R/O other DXs first and treat
-
Vaginal atrophy - use smallest speculum for exam
- Low estrogen state - similar to menopause, post-partum lactation, cancer treatment
- Can cause pain on its own, or predispose to other diagnoses
- BV, UTI, cervicitis - TX
- Trauma from penetration or friction
Treatment for pelvic pain in transmasculine patients
Vaginal estrogen
* Localized dose
* Not systemically absorbed, short course
* Will not cancel out Testosterone therapy tx
* Creams > tablets
Treatment for cyclic pelvic pain in transmasculine patients
- Can be caused by T INJ and/or penetration/orgasm
- Switching from INJ → transdermal if correlated w/INJ timing
- Pelvic floor PT
- Hysterectomy/endometrial ablation
- General pelvic pain treament options (consider trauma/PTSD w/dysphoria)
Bleeding in transmasculine patients
Differentials
- Pregnancy
- Fibroids
- Endometrial polyps
- Cervicitis
- Malignancy
- PCOS
- Thyoid dysfunction
- Eating disorder
Delaying T if patient shows irregular bleeding?
- Depends, wait until full work-up is done to decide delaying
- Weight risks/benefits of delaying T
Diagnostic, dose work-up for persistent bleeding after 6-12 months on T
- Consider body physique for testosterone dosing
- Larger build → aromatizing testosterone → estrogen tissue (estradiol)
- May help to decrease T
- Missing/skipping INJs d/t financial cost
- Larger build → aromatizing testosterone → estrogen tissue (estradiol)
- Labs: Testosterone, FSH, LH
- If both WNL + testosterone in male range → further workup
- Endometrial polyps, endometrial hyperplasia, polyps, maligancy
- If both WNL + testosterone in male range → further workup
- Imaging: Pelvic U/S, endometrial biopsy, transabdominal U/S alone (less invasive)
Treatments for bleeding in transmasculine patients
- Adjust T
- Add progestin
- Hysterectomy
- Endometrial ablation
- Higher T
- BC, Depoprovera, IUD, etc.
