transgender healthcare Flashcards
what is binary gender?
only two distinct genders exist- man and
woman
what is cisgender?
a person whose gender corresponds to the sex
that they were assigned at birth
what is gender?
a range of attributes linked to male and female, not linked to an individual’s biological sex
what is gender expression?
how an individual performs their sense
of self, through their actions, interests, and appearance
what is gender dysphoria?
an individual’s unhappiness at the
disparity between the gender which they were assigned at birth and their gender identity
what is gender identity?
an individual’s feeling of what gender
they most associate with
what is heteronormativity?
: the idea that heterosexuality is
the norm for sexual orientation and gender binaries of male and female are the only ones that exist
what is medicalisation?
the process by which non-medical
problems and conditions become known by and treated as medical ones
what is pharmacotherapy?
the treatment of a disorder,
disease, or condition with medication
what is queering?
a method of questioning and challenging
processes and systems in society that focus on, or are based upon, heterosexuality or gender binaries
what is sexuality?
the way in which an individual expresses
themselves sexually through different feelings and behaviours
what is transgender?
desire to move away from a gender that
has been assigned to that person at birth
what is transphobia?
a collection of ideas that incorporate a
range of negative attitudes, feelings, or actions towards transgender people
how is equality and diversity regulated in healthcare?
- All healthcare services have a duty to treat their patients with respect and adhere to relevant legislation, such as the Equality Act, 2010, and Gender Recognition Act, 2004
how did the medical professional medicalised transgender patients?
- Transgender patients forced to conform to pre-existing medical beliefs to access care (Hird, 2022)
- Labelling these patients as ‘ill’ or ‘needing cured’
perpetuates the idea that they need ‘healed’ or ‘cured’ - This medical and psychiatric scrutiny allows the pursuit for a ‘cause’ of transgenderism to continue
what did medicalisation of trans patients lead to?
n led to inclusion in Diagnostic and
Statistical Manual of Mental Health Disorders (DSM) of the American Psychiatric Association (APA)
what are general health concerns?
- Co-morbidities:
– Consider if existing conditions may be exacerbated by treatment with or deficiency of oestrogen and testosterone - Obesity- why is this a concern?
– Increased risk of adverse effects and complications related to hormone treatment.
what are the effects of gender dysphoria?
This sense of unease or dissatisfaction may be so intense it can lead to depression and anxiety and have a harmful impact on daily life
when can HCP refer for gender dysphoria? how do they help?
(>17 years) to the Gender Dysphoria service (Currently developing a self referral route)
* Clinics offer services such as: psychological support and counselling, speech and language therapy and cross-sex hormone therapy
* May apply to legally change their gender
what sugery options are there for trans people from female to male?
- In patients transitioning female to male (FTM) may involve: removal of both breasts (bilateral
mastectomy), nipple repositioning, dermal implant, construction of a penis (phalloplasty) construction of a scrotum (scrotoplasty) and testicular implants and a penile implant. - In addition, removal of the womb (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy) may also be considered
what surgery options are there for mens transitioning to women?
- In patients transitioning male to female (MTF) may involve: removal of the testes (orchidectomy), removal of the penis (penectomy), construction of a
vagina (vaginoplasty), construction of a vulva
(vulvoplasty) and construction of a clitoris
(clitoroplasty) - Breast implants and facial feminisation surgery are not routinely available on the NHS
what is the aim of hormone treatment?
– Reduce gender dysphoria
– Alter secondary sex characteristics
– It can provide significant comfort to people who experience gender dysphoria
when is hormone treatment indicated?
– Persistent, well-documented gender dysphoria
– Capacity to make a fully informed decision and to consent for treatment
– If significant medical or mental concerns are present, they must be reasonably well-controlled
when is estradiol recommended?
- Alleviation of gender dysphoria in MTF patients
- Only estradiol and its esters are recommended for treatment of gender dysphoria.
what are the contraindications/ cautions for estradiol?
- Contradindications
– Hx oestrogen dependent tumours. Recent thrombotic disease
(new / unstable angina or recent myocardial infarction / stroke / TIA) - Cautions:
- Obesity, smoking, breast cancer, hx thromboembolic disease, CAD, high CV risk, poorly controlled diabetes, severe migraine,
hypertriglyceridemia, severe liver disease
who would testosterone be indicated in?
- Testosterone for alleviation of gender dysphoria in FTM patients
- Goal to achieve trough serum testosterone levels in the lower third of the male reference ranges
who would transdermal testosterone preparations be recommended for?
– Consider in older patients, obesity and smokers. May confer lower risk of polycythaemia, thrombosis and
liver dysfunction.
– Allow smaller doses and increments
who would testosterone be contraidicated in/ cautioned?
- Contradindications
– Hx oestrogen dependent tumours. Recent thrombotic disease (new / unstableangina or recent myocardial infarction / stroke / TIA)
– Sustanon® contains arachis (peanut) oil and should not
be prescribed for patients known to be allergic to peanut - Cautions:
- Obesity, smoking, breast cancer, hx thromboembolic disease, CAD, high CV risk, poorly controlled diabetes, severe migraine, hypertriglyceridemia, severe liver disease
who are GnRH analogues indicated in?
- Alleviation of gender dysphoria in FTM patients AND MTF patients AND as ‘puberty blocker’
Used to achieve maximum suppression of endogenous sex hormones
what is the role of GnRH analogues in male assigned?
- Inhibit the secretion of pituitary gonadotrophins leading to low circulating
levels of testosterone - Treatment goal is to achieve equivalent female levels of testosterone
what is the role of GnRH analogues in female assigned?
- Suppression of endogenous sex steroid production and, thereby,
attenuation of secondary female sexual characteristics such as menstruation - Maximises masculinisation achieved by testosterone
- They inhibit the secretion of pituitary gonadotrophins leading to low
circulating levels of ovarian hormones
what is the role of GnRH analogues in children and young people?
- Suppress puberty by delaying the development of 2’ sexual characteristics.
Alleviate distress associated with the development of 2’ sex characteristics,
providing time for on-going discussion and exploration of gender identity
before deciding whether to take less reversible steps
who are GnRH analogues contraindicated in/ cautioned in?
- Contraindications:
– Pregnancy, breastfeeding - Caution:
– Metabolic bone disease, uncontrolled diabetes
who are antiandrogens indicated in?
- Alleviation of gender dysphoria in male
assigned adults - Not as commonly used in the UK
