Transgender Health Flashcards
Define biological sex.
Sex assigned at birth.
Define binary gender.
Man and woman
Define cisgender.
A person whose gender corresponds to their biological sex.
Define gender.
Attributes linked to male and female not linked to an individual biological sex.
Define gender expression.
How an individual performs their sense of self, through their actions, interests and appearance.
Define gender dysphoria.
Individual’s unhappiness at the disparity between gender which they were assigned at birth and their gender identity.
Define gender identity.
Individual’s feeling of what gender they most associate with.
Define heteronormativity.
Idea that heterosexuality is the norm for sexual orientation and gender binaries of male and female are only ones that exist.
Define medicalisation.
Process which non medical problems and conditions become known by and treated as medical ones.
Define pharmacotherapy.
Tx of disorder, disease or conditions with medications.
Define queering.
Questioning and challenging processes and systems in society that focus on heterosexuality or gender binaries.
Define sexuality.
Indiividuals expresses themselves sexually through different feelings and behaviours.
Define transgender.
Desire to move away from gender that has been assigned to that person at birth.
Define transphobia.
Collection ideas that incorporate a range of negative attitudes, feelings or actions towards transgender people.
Explain the importance of equality and diversity in healthcare.
All HC services have a duty to tx their px with respect and adhere to relevant legislation.
Explain the medicalisation of transgender px.
Helps assert their authority.
Transgender px forced to conform to pre-existing medical beliefs to access care.
Leads to inclusion in Diagnostic and Statistical Manual of Mental Health Disorders of American Psychiatric Association.
DSM-5 changes gender identity disorder to gender dysphoria.
Define gender dysphoria.
A sense of unease that a person meant have because of a mismatch between their biological sex and their gender identity.
What are the surgery options for transgender?
Female to male:
- Removal of both breast (bilateral mastectomy)
- Nipple repositioning
- Dermal implant
- Penis construction (phaloplasty)
- Scrotum (scrotoplasty)
- Testicular/penile implants
- Womb removal (hysterectomy)
- Ovaries and Fallopian tubes removal (salpinooophorectomy)
Male to Female:
- Testes removal (orchidectomy)
- Penectomy (penis removal)
- Vaginoplasty (vagina construction)
- Vulvoplasty (vulva construction)
- Clitoris construction (Clitoroplasty)
- Breast implants
- Facial feminisation surgery
Explain the process of hormone treatment.
Aims:
Reduces gender dysphoria
Alters secondary sex characteristics
Comfort to people to experience gender dysphoria.
Indication:
Persistent, well-documented gender dysphoria
Capacity to make a fully informed decision and consent for tx.
If medical/mental concerns are present, they must be well-controlled.
Off-label Rx:
Used outside the indications approved by MHRA.
Explain the main features of Estradiol.
Oestrogen steroid hormone and naturally occurring female sex hormone.
Alleviation of gender dysphoria in MTF.
Estradiol and its esters are recommended for tx of gender dysphoria.
C/I:
- Hx of oestrogen dependent tumours
- Recent thrombotic disease (new/unstable angina/recent MI/stroke/TIA)
Cautions:
Obesity
Smoking
Breast cancer
Hx thromboembolic disease
CAD
High CV risk
Poorly controlled diabetes
Severe migraine
Hypertriglycerdemia
Severe liver disease
Px undergoing surgery will need to come off oestrogen approx 6 weeks prior to planned operation to reduce the risk of thromboembolism.
After surgery, px will go back on oestrogens 2-4 weeks.
Explain the main features of testosterone.
Alleviation of gender dysphoria in FTM.
To achieve trough serum testosterone levels in lower third of male reference range.
Transdermal preparations:
Older px, obesity, smokers.
Low risk of Polycythaemia, thrombosis and liver dysfunction
Small dose increments.
C/I:
Hx of oestrogen dependent tumours, recent thrombotic disease (new/unstable angina or recent MI/Stroke/TIA)
Sustanon contains arachis (peanut) oil = not for px with peanut allergy.
Cautions:
Obesity, smoking, breast cancer, Hx thromboembolic disease, CAD, high CV risk, poorly controlled diabetes, severe migraine, hypertriglyceridemia, severe liver disease
Explain the main features of GnRH analogues.
Alleviation of gender dysphoria in FTM and MTF and puberty blocker.
Used to achieve max suppression of endogenous sex hormones.
Role:
- Male assigned: inhibits secretion of pituitary gonadotropin leading to low circulating levels of testosterone. Tx goal is to achieve equivalent female levels of testosterone.
- Female assigned: suppression of endogenous sex steroid production and attentuation of secondary female sexual characteristics e.g. menstruation. Max masculinisation achieved by testosterone. Inhibits secretion of pituitary gonadotropin leading leading to Lowe circulating levels of ovarian hormones.
- Children/young people: Suppress puberty by delaying the development of secondary sexual characteristics. Alleviate distress associated with development of 2’ sex characteristics, providing time for ongoing discussion and exploration of gender identity before declining whether to take less reversible steps.
C/I: Pregnancy, breastfeeding
Caution: Metabolic bone disease, uncontrolled diabetes
Explain the main features of anti-androgens.
Alleviation of gender dysphoria in male assigned adults.
Not commonly used in UK
