Transgender Health Flashcards
Transgender definition
Desiring and often making lifestyle changes to live as a different gender.
- sex assigned at birth does not align with gender identity
Intersex definition
Describes diversity in sex characteristics whereby reproductive organs/genitalia or other sexual anatomy differs from traditional expectations for female or male
- can be seen at birth or in puberty
Names/pronouns
Includes
She/her/hers
He/him/his
They/them/theirs
Must ask directly to make sure you are using the proper pronouns (dont assume).
Layers of gender identity
1) sex assigned at birth
2) inner sense of gender
3) how gender is expressed outwardly
4) how gender is perceived by others
1 -> 4 starting from inner to outer
How do you screen trans individuals in primary care
Based on their behavior and body parts at the time.
Provide hormone therapy for trans individuals that wish to have it
- absolute contraindications in adult = estrogen/testosterone-sensitive tumors
Risks of hormone therapy = VTE/erythrocytosis/insulin resistance and hyper triglyceridemia
What is the most importaint protective factor for trans youth?
Parental support
Gender-affirming care
Is the best form of care for patients who are experiencing gender dysphoria
Includes:
- screen patient based on what they have
- non judge mental encouragement to explore gender identity
- refer for gender affirmation surgeries (if applicable)
- provide hormone therapy (if indicated)
- support through social and legal transition
Gender dysphoria
Significant incongruence between ones experienced gender and the gender assigned at birth lasting > 6 months and leading to persistent distress and or impairment in social/educational/occupational
Differences between adults and children gender dysphoria
Very similar except
Adults = desires to be rid of primary/secondary sex characteristics
Children = need 6 parts of DSM-5 Adults = need 2 parts of DSM-5
Parental approaches with children with gender dysphoria/incongruence
Affirming is always #1
- tell the parents to encourage their child to explore their gender
Wait and see approach
- dont tell the kids they are wrong, but dont promote it
Redirection
- parents redirect the child towards their assigned sex
- don’t encourage this but if this is happening its challenging to reverse
Reparative therapy is never allowed
Gender incongruence vs gender dysphoria
Similar in that both need the person to want to partake in behavior not associated with their assigned sex
However, incongruence is NOT a mental disorder and it DOES NOT cause distress by itself
-(if any distress is present its social only)
Does a patient need to have gender dysphoria in order to get sex hormone therapy (GnRH agonist)?
Yes it is required in the diagnosis.
- often only if serious and needs the MHP, endocrinologist and patient/family to all consent and agree to treatment
When does a person usually develop gender identity
Piagets Preoperational stage (2-7 yrs)
This is in contrast to sexuality which is formal operational stage
Difference between gender dysphoria and gender incongruence
Are essentially the same except that dysphoria causes marked social/clinical stress and impairment for at least 6 months
Criteria for gender-affirming hormone therapy
1) qualified MHP confirms adolescent has gender dysphoria
- as well as other coexisting conditions that could interfere with treatment
2) adolescent has significant mental capacity to give informed consent
3) parents and caretakers have consented and the patient has given informed assent
- can give just consent to the patient if > 18 years and mental capacity is there
4) pediatric endocrinologist confirms that GnRH agonism is okay (no contraindication) and that the adolescent has started puberty
