Transgender Health (Grin)

Question 1

Definition of Gender Identity

Answer 1

one’s internal sense of being male, female, neither, both or another gender(s)

Question 2

Definition of Gender Expression

Answer 2

physical manifestation of one’s gender identity through clothing, hairstyle, voice, body shape; does NOT tell you about sexual orientation or gender identity

Question 3

Transgender female/ trans-feminine individual

Answer 3

assigned male at birth, gender identity is female/feminine spectrum

Question 4

Transgender male/trans-masculine individual

Answer 4

assigned female at birth, gender identity is male/masculine spectrum

Question 5

What are 3 important roles as a physician treating transgender population?

Answer 5

1. Understand basic aspects of transgender health
2. Provide affirming, respectful care to all patients
3. Help make health care a safe space for all patients

Question 6

Definition of gender incongruence

Answer 6

sex assigned at birth does not align with gender identity

Question 7

Definition of gender dysphoria

Answer 7

clinically significant distress or impairment related to incongruence between sex assigned at birth and gender identity

Question 8

What is the goal of gender-affirming hormone therapy?

Answer 8

to allow acquisition of secondary characteristics more aligned with the individuals gender identity

Question 9

What are the 4 criteria for initiating hormone therapy?

Answer 9

1. marked and sustained gender incongruence
2. capacity to consent for treatment
3. mental health and physical conditions that could have negatively impact outcome of treatment have been assessed
4. Understands effects of hormone therapy on reproduction, and have explored fertility preservation options

Question 10

Is a formal mental health evaluation (ie psychiatry evaluation) required prior to initiating hormone therapy?

Answer 10

NO. it is not required prior to initiating treatment

Question 11

Why is masculinizing hormone therapy not given orally?

Answer 11

Testosterone; only delivered via injection to topically; not given orally due to hepatotoxicity

Question 12

Masculinizing hormone therapy effects

Answer 12

facial/body hair growth (onset 3-6 mo)
Scalp hair loss (onset >12 mo)
Clitoral enlargement (onset 3-6 mo)
Deepened voice (onset 3-12 mo)

Question 13

Risks of masculinizing hormone therapy

Answer 13

Testosterone; polycythemia/erythrocytosis; monitor CBC in these patients

Question 14

Feminizing hormone therapy

Answer 14

Estradiol and androgen blocker (spironolactone)

Question 15

Feminizing hormone therapy effects

Answer 15

breast growth (onset 3-6 mo)
decreased testicular volume (onset 3-6 mo)

Question 16

Feminizing hormone therapy risks

Answer 16

Venous thromboembolism (VTE); risk is higher in smokers

Question 17

Why give an androgen blocker?

Answer 17

maximize blockage of testosterone while avoiding supraphysiologic estradiol usage; spironolactone commonly used; risk for hyperkalemia

Question 18

Puberty suppressing agents

Answer 18

GnRH analogues; “pause” puberty; delay secondary characteristics; prevent future gender affirming surgeries

Question 19

Fertility considerations of gender-affirming hormone therapy

Answer 19

may reduce fertility; options on preservation before starting (sperm banking and egg cryopreservation)

Question 20

Does hormone therapy act as a form of contraception?

Answer 20

No. these patients should be offered contraception options of the could produce a pregnancy and do not want to become pregnant

Question 21

Cancer screenings in trans-masculine patients

Answer 21

Cervical cancer screening - Pap test starting at 21 yrs
Breast cancer screening - mammogram starting at 50 yrs

Question 22

Cancer screenings for trans-feminine patients

Answer 22

Breast cancer screening - mammogram if exposed to feminizing hormones >5 yrs; if not then starting at 50 yrs
Prostate cancer screening - PSA starting at 55 yrs

Question 23

What are two things that intake forms should include?

Answer 23

1. ask separately about sex assigned at birth and gender identity
2. offer multiple options for gender identity