Transgender care

Question 1

What is feminizing therapy?

Answer 1

can cause decreased erectile function, decreased testicular size, breast growth, incr body fat.
- Transdermal estradiol=preferable
- Antiandrogens (spironolactone, cyproterone, GnRH agonist, 5-alpha reductase inhibitors)

Question 2

What is recommendation for surveillance for feminizing therapy?

Answer 2

labs: estradiol and total testosterone, sex hormone binding globulin and albumin q3 months in first year to titrate estrogen.
If taking spironolactone, check K and Cr q3 months then yearly.

Question 3

Why is the transgender male at increased risk of endometrial and ovarian cancer?

Answer 3

Androgen therapy (in theory) bc incr aromatization to estrogen so possibly unopposed estrogen

Question 4

Transgender males need what discussion before initiation of hormone therapy?

Answer 4

Fertility preservation