Real Trans

Question 1

assigned sex

Answer 1

designated at birth

Question 2

sexual orientation

Answer 2

romantic/physical/emotional attraction

Question 3

gender identity

Answer 3

internal sense of being male/female

Question 4

transgender

Answer 4

gender identity is different from assigned sex

Question 5

trans man

Answer 5

identifies as man; assigned female at birth (also called FTM- female to male)

Question 6

trans woman

Answer 6

• identifies as woman; assigned male at birth (also called MTF- male to female)

Question 7

cisgender

Answer 7

gender identity, expression and behavior match assigned sex

Question 8

gender nonbinary/genderqueer

Answer 8

identifies as neither entirely male or female

Question 9

transition

Answer 9

• period of time when person begins to live as gender identity rather than assigned sex

Question 10

subjective evaluation of the TRANS

Answer 10

Determine gender identity and how patient wishes to be addressed
* Elicit history based on focused information pertaining to CC, as with all
patients
* High levels of sensitivity are needed, as gender diverse patients are often
guarded
* DO NOT ask questions out of curiosity that do not pertain to current CC or
HPI
* DO affirm to your patient a willingness to discuss any concerns- many will
open up to you on this basis
* DO confirm all medications, both prescribed and OTC in a non-judgmental
manner
* DO ask specific questions to confirm

Question 11

physical exam FTM

Answer 11

binding breasts, mastectomy w/ male chest contouring
hormonal therapy to provide masculine sex characteristics
monitoring and screening

Question 12

physical exam of the trans folk- things to understand

Answer 12

• Understand procedures or treatments that the patient has undergone
• Gender re-assignment surgery: “top surgery”, “bottom surgery”
• Hormonal therapy: suppression of sex hormones, and maintenance of hormone levels
  for affirmed gender
• Some patients may choose non-pharmacologic or non-surgical treatments- be aware
  of the patient’s choices
• Physical exam should be based on the focused presenting issue

Question 13

FTM risks of hormone therapy and contraiidications

Answer 13

• Risks: acne, polycythemia, sleep apnea, weight gain, male pattern balding, elevated LFT,
  hyperlipidemia, reduced fertility
• Contraindications: pregnancy, unstable CAD, untreated polycythemia
• For those with intact uterus/ovaries a nonhormonal IUD is recommended if sexually
  active in contact with sperm

Question 14

FTM monitoring and screening

Answer 14

Q3mos for one year, then annual: LFT, CBC, Lipids and testosterone level

• Individualized tests may include pap smear, mammogram, STD/depression/domestic

violence/tobacco screenings

Question 15

MTF how they do it

Answer 15

Compression of genitals or genital reconstruction; breast augmentation,
nonsurgical augmentation or padding

• Hormonal therapy: androgen blockers (such as Spironolactone), GnRH agonists, and/or estrogen replacement

Question 16

MTF risks of hormone therapy

Answer 16

Risks: electrolyte disturbance (hyperkalemia),

hypotension,

DVT,

weight gain,

gallstones,

hypertriglyceridemia,

infertility

Question 17

monitoring and screening for MTF

Answer 17

Q3 mos for one year, then annual: electrolytes, lipid levels, prolactin level

• Blood pressure,

testicular/prostate exams (including PSA) as applicable,

mammogram if breast tissue present,

possibly DEXA scan

Question 18

takeaways for the trans community

Answer 18

• Treat ALL patients with respect
• Seek to understand your patient
• Be aware of current and past gender transition treatments
• Carefully consider laboratory monitoring and screenings