Transgender Flashcards
List the biochemical goals of hormone therapy in transgender care
- Suppress endogenous sex hormone production
- Maintain sex hormone levels within the normal range for the person’s affirmed gender
What tanner stage should you start treatment of transgender patients with Lupron?
Tanner 2
When should you start treatment of transgender patients with gender affirming hormones?
When a multidisciplinary team has confirmed the persistence of gender dysphoria AND sufficient mental capacity to give informed consent (typically age 16, minimal published studies in age 13.5-14)
How often should transgender patients be monitored clinically and with lab evaluation while on pubertal suppression?
- Every 3-6 months: height, weight, sitting height, blood pressure, Tanner staging
- Every 6-12 months: lab tests (LH, FSH, estradiol/testosterone, 25 OH vitamin D)
- Every 1-2 years: DEXA scan, bone age x-ray
When should gender-affirming surgery be considered?
After at least 1 year of consistent and compliant hormone treatment (unless hormone therapy is contraindicated or not desired)
At what age can you consider gender-affirming surgery with gonadectomy/hysterectomy in transgender patients?
- Age 18 or the age of majority in the patient’s country
Define gender dysphoria
Persons who are not satisfied with their designated gender (APA definition)
The prevalence of gender dysphoria in individuals with 46,XX CYP21A2 CAH is ______ than the baseline population prevalnce
higher
This supports the concept that gender identity is impacted by androgen exposure in-utero
What percentage of pre-pubertal children with gender dysphria persist into adolescence?
15%
More likely to persist if it is extreme dysphoria or if they have socially transitioned
What are the DSM5 criteria for GD in adolescents and adults?
A) Marked incongruence between one’s experienced vs. natal gender of at least 6 months, manifested by 2+ of:
- incongruence between experienced gender and primary/secondary sex characteristics
- desire to be rid of primary/secondary sex characteristics
- desire for sex characteristics of the other gender
- desire to be of the other gender
- desire to be treated as the other gender
- conviction that one has typical feelings/reactions of the other gender
B) Condition is associated with distress or impairment in functioning
Specify if: associated with DSD, or post-transition
What factors may contribute to post-operative regret in transgender patients?
- Poor quality of surgery
- Severe psychiatric comorbidity
- Lack of support
List the eligibility criteria for transgender adolescents to proceed with gender-affirming hormone therapy
- Qualified MPH has confirmed (1) the persistence of GD (2) Any coexisting psychological, medical or social problems have been addressed and (3) Adolescent has sufficient mental capacity to consent to this potentially irreversible treatment
- Adolescent (1) has been informed of effects of treatment and (2) has given informed consent
- Endocrinologist (1) agrees with the indication and (2) has confirmed no medical contraindications
When should counselling about fertility preservation be done in transgender patients?
- Before pubertal suppression (adolescents) or before cross-sex hormone therapy (adolescents and adults)
List 2 advantages to starting puberty-blocking early (T2) in transgender adolescents
- Improved physical outcome (prevent undesirable secondary sexual characteristics)
- Improved psychological experience
Which secondary sex characteristics are irreversible after pubertal progression in males and females?
- Males: Adam’s apple, low voice, male bone configuration (large jaw, big feet and hands), tall stature
- Females: breasts, female body habitus, relatively short stature
