Transcare Flashcards
What are the masculinizing agents for female -> male
Testosterone 20-50 mg Qweekly IM/SC
GnRH analogues -> typically only reserved for adolescents
What are the irreversible changes once you start testosterone
voice changes
clitoral growth are irreversible
scalp hair loss
facial/body hair growth
When does deepened voice occur?
6-12 months onset
Expected max time 1-2 years
When do you except cessation of menses once testosterone started ?
1-6 months
CI to testosterone?
PPPHAU
P-pregnancy / BF
P- poorly controlled psychosis or acute HI
P-psych conditions that limit consent
H-hypersensitivity
A- active or known hormone sensitive cancers (breast, endometrial)
U-unstable ischemic CVD
is cessation of menses reversible?
yes
Monitoring timeline for pt on testosterone
baseline, 3 months, 6 months and 12 months
What are baseline labs for those on testosterone ?
CBC (transient elevation of RBC can occur with testosteron)
ALT (transient elevation of LFTs and resolve unless cause identified)
AST
A1C
Glucose fasting
Lipid
Total Testosterone
What labs do you monitor at 3 months, 6 months and 12 months with testosterone
3-6 months -> CBC, total testosterone
12 months -> same as baseline
What if your transman patient complains of sudden vaginal bleeding
increase risk of endometrial cancer with testosterone > should investigate for vaginal bleeding without explanation warrants follow up
Atrophic changes to vagina with testosterone use, what are options for the pt?
use local lubricants and moisturizers
Osteoporosis risk and testosterone use, what are prevention options for pt?
vit D 1000 u
calcium 1200 mg
moderate gradual weight bearing exercises
BMD testing >65 years but if they have been on testosterone for >2 years, they can start at 50.
What are the feminimizing hormones (male -> female)
- Anti-androgens
-Spironolactone 50 mg daily
-Cyproterone 12.5 mg- 25 mg - Estrogens
need to wait 1-3 months after anti-androgens to start estrogen
transfermal > oral (fewer side effects) ; recommended for patients >40 with CVS, thromboembolic or liver disease
AJUNCT ONLY
3. Progestins (not routinely recommended)
-only use if androgen suppression inadequate
AE= increased risk of breast cancer, heart disease, stroke and VTE (when combined with estrogen)
What are the SE of spironolactone
Hyperkalemia
renal impair
polyuria
polydipsia
hypotension
rash
what are the SE of cyproterone
increased liver enzymes
hepatotoxic
depression
VTE risk
CBC changes
CI to starting estrogen?
CLPHAU
unstable ischemic cardiovascular disease
cardiovascular disease
estrogen dependent cancer
end stage liver disease
psych conditions that limit ability to provide consent
hypersensitivity to component
Monitoring timeline for those on feminizing therapy
baseline, 3 months, 6 months and 12 months and q yearly after that
What are the baseline blood work?
3 months, 6 months and 12 month blood work?
For male -> female
Baseline:
CBC
ALT (estrogen causes transient increase in LFTs)
Cr
Lytes
A1C
Total testosterone
Estradiol
Prolactin (increased risk: s/s visual disturb, galactorhea, new onset headache -> most common with cyproterone.)
Month 3-6: (only estradiol and testosterone, * if indicated)
CBC*
ALT*
Cr * (not the same for female-male)
Lytes * (don’t measure this for f-m)
Total testostone
Estradiol
Month 12:
Same as baseline
Goal: checking to see the degree of androgen suppression
What is the estradiol target ?
200-500 pmol/L
If your patient is on spironolactone, what do you monitor in terms of bw? how often?
Lytes q4-6 weeks following initiation (can cause hyperkalemia)
What are the irreversible effects of feminizing hormones?
breast growth
When should you expect to see breast growth in estrogen therapy?
3-6 months
expected max effect 1-2 years
What are the recommendations for osteoporosis guidelines for male->female transitioners
*increased risk
usually >65 years you start
screen at 50 if >2 years on hormone therapy
Prevention:
Take 1000 units/ day Vitamin D
1200 mg/day of Calcium
wt bearing exercises (higher reps, lighter weights)
How do you mitigate risk of breast cancer with estrogen therapy
CI- if you have a family hx of
Mammo Q2 years if >50 years AND on estrogen for >5 years.
