Transgender

Question 1

Transfeminine Adults: Pharmacological Therapy with Estrogen

Answer 1

Estrogen therapy

• used in combination with an antiandrogen
• Permanent effects:
• – Breast development, decrease in testicular volume and sperm production
• Reversible effects
• – fat redistribution, decrease in muscle mass, softening of the skin, decreased erections and libido, decrease in scalp hair loss, slowed male-patterned hair growth
• Unchanged
• – Vocal pitch, Adam’s apple, already-established facial/body hair

Question 2

Transfeminine Adults: Estrogen Risks

Answer 2

Risks:

• Thromboembolic events, CAD, lipid panel changes, hyperprolactinemia, prolactinomas, and bone mineral density changes
• Reports of prostate cancer

Question 3

Transfeminine Adults: Pharmacological Therapy with Androgen-Suppressing Agents

Answer 3

Spironolactone

• Suppressive effects on testosterone synthesis
• Aids in breast development, slightly reduces male-patterned hair growth, & stops male-patterned hair loss
• ADRs: hyperkalemia (monitor electrolytes)

Alpha-5 reductase inhibitors
- Used for male pattern hair loss

Gonadotropin-releasing hormone (GnRH) analogues
- Decrease the production and effects of testosterone

Alternative antiandrogens
- medroxyprogesterone and bicalutamide

Question 4

Transmasculine Adults: Pharmacological Therapy

Answer 4

Testosterone therapy:

• Goal of treatment: to achieve gender-affirming secondary sex characteristics
• Injected, gel, patches, oral tabs, implanted pellets
• Deepening of voice typically begins within first 3 months
• Menses typically cease within 6 months

Question 5

Transmasculine Adults: Pharmacoloical Therapy Risks

Answer 5

Persistent menstrual bleeding
Erythrocytosis
Androgenetic alopecia
Migraines may be exacerbated

Question 6

Transmasculine Adults: Pharmacological Therapy for Menstrual Cessation

Answer 6

• Levonorgestrel (LNg) intrauterine device (IUD) (Mirena, Skyla)
• Depot medroxyprogesterone acetate (DMPA, Depo-Provera)
• Etonogestrel implant (Nexplanon)
• Danazol synthetic androgen

Question 7

Transmasculine Adults: Pharmacologial Therapy for Contraception

Answer 7

Transmasculine adults typically avoid estrogen-containing methods
Long-acting reversible contraceptives:
- Levonorgestrel (LNg) intrauterine device (IUD) (Mirena, Skyla)
- Depot medroxyprogesterone acetate (DMPA, Depo-Provera)
- Etonogestrel implant (Nexplanon)

Question 8

Transgender: Treatment of Adolescents

Answer 8

Upon signs of puberty initiation, the use of GnRH analogues is recommended for both male- and female-identifying youth
- Tanner Stage 2

Delaying puberty allows adolescents to explore gender identity
- Reversible

Counseling should be provided regarding preservation of fertility