Module 10. Trans care <3

Question 1

When are three most common gender dysphoric times for LQBTQ+ youth?

Answer 1

• starting school
• puberty
• when peers start dating

Question 2

What are the medication options for Trans-Female feminizing hormone therapy?

Answer 2

1. Antiandrogens:
   -Spironolactone
   - Cyprotrone
2. Progestins
3. Estrogen

Question 3

When starting a patient on spironolactone for trans-female hormone tx, what baseline bw do you need any why?

Answer 3

total testosterone, Na, K, and Creatine

Spironolactone is potassium sparing, monitor K, and it can cause renal impairment so you must monitor creatine

baseline, 3-6months, 12 months

Question 4

When starting a patient on Cyprotrone for trans-female hormone tx, what baseline bw do you need any why?

Answer 4

Total Testosterone
AST/ALT
CBC
Na, K

it can cause hepatoxicity and anemia so you must monitor

baseline, 3-6months, 12 months

Question 5

What are contraindications to starting a patient on spironolactone?

Answer 5

• Renal insufficiency
• Addisons disease
• Avoid with ACE inhibitors/ARBs

Question 6

Would you use progesterone for hormone treatment in Trans female patients?

Answer 6

You can… however its very controversal

The side effects include: weight gain, edema, mood swings

And there has been a lack of evidence to support feminizing results. Generally its not used

Question 7

Can you start feminizing hormone therapy in a Trans female patient who is 65?

Answer 7

First you must assess for contraindications to treatment, but its preferred to use spironolactone antiandrogen as Cyprotrone has higher VTE risk

transdermal estradiol is recommended
preferentially for transgender feminine patients
who are over 40 or who have risk factors for
cardiovascular (CV) or thromboembolic disease.
It is most commonly administered in the form
of the estradiol patch (“Estradot”), w

Question 8

What fertility preservation options are available for trans females before starting hormones?

Answer 8

Feminizing hormones will reduce sperm production and motility

They may preserve their sperm through
- sperm cryopreservation
- Testicular Sperm Extraction

Question 9

what are possible permanent changes with trans feminine hormone therapy?

Answer 9

1. Breast Growth
2. Infertility
3. Genital changes (decrese in size of testicles)

Question 10

What baseline bloodwork do you need when starting testosterone for masculinizing trans tx?

Answer 10

1. CBC
2. Total Testosterone
3. AST/ALT
4. Lipid profile
5. A1C

CBC and testosterone should be monitored q3

Question 11

Why do you need to monitor CBC so closley (every 3 months) with testosterone treatment?

Answer 11

because of the risk of polycythemia

Question 12

If your patient wants to start IM testosterone for masculinizing treatment but has hx of migraines what would you advise?

Answer 12

transdermal testosterone would be better option