Transgender Healthcare and Hormone Therapy Flashcards
1
Q
What does Gender Incongruence mean?
A
Gender incongruence refers to an individual’s discontent with their assigned gender and the identification with a gender other than that of their birth sex.
2
Q
What does Gender Dysphoria mean?
A
Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics.
3
Q
Both gender incongruence and gender dysphoria are not to be confused with … and …
A
sexuality and transvestites
4
Q
Transitioning
- social gender role change - changing what 3 things?
- treatment with …
- suppress biological … …. function
- this is …% reversible
- there is less reversibility however with … and …
- should discuss preservation of … first
- possibly … option - not everyone will want to or can
A
- social gender role change - changing pronouns, clothes, name
- treatment with hormones
- suppress biological sex hormone function
- this is 90% reversible
- there is less reversibility however with breasts(trans-male) and hair (trans-female)
- should discuss preservation of fertility first
- possibly surgical option - not everyone will want to or can
5
Q
Pronouns
- using the correct pronoun is very important
- especially for those just starting to transition who may not yet ‘look the part’
- don’t make …
- ask politely
- if you make a mistake, apologise
- gender neutral pronouns - what are they?
- do not have do define gender in conversations
- take care in … and …
A
- using the correct pronoun is very important
- especially for those just starting to transition who may not yet ‘look the part’
- don’t make assumptions
- ask politely
- if you make a mistake, apologise
- gender neutral pronouns - what are they - they/their
- do not have do define gender in conversations
- take care in notes and letters
6
Q
Gender Identity Clinic (GIC)
- … approach
- counselling / psychotherapy / psychological support
- also can have therapy for voice, known as …
- endocrinology for …
- surgery - referral may include …
A
-
Multidisciplinary (MDT) approach
- counselling / psychotherapy / psychological support
- also can have therapy for voice, known as speech and language therapy
- endocrinology for hormones
- surgery - referral may include chest, hysterectomy/oophorectomy, gonadectomy, genital, ENT, facial
7
Q
Oestrogen treatment - effects
- hair - what are the effects on facial and body hair? what about scalp?
- breasts - what to expect?
- maximum effect is achieved how many years after treatment? - do higher doses have a greater effect?
A
-
hair
- face - some effect - mechanical forms often required still
- body hair - more effect
- no effect on lost scalp hair but does prevent further loss
-
breasts
- expect one cup size within mother’s
- gradual oestrogen treatment for optimal breast development - otherwise fuse breast buds with extra hormones
- maximum effect is achieved 2 years after treatment - higher doses does not result in a greater effect
8
Q
Oestrogen treatment - management
- oral or transdermal … (patch/gel)
- higher or lower doses than post-menopausal HRT?
- Oestradiol is … than ethinylestradiol or conjugated equine oestrogens
- GnRH analogue to suppress …
- depot IM injection - how often?
- not required after …
- Venous thromboembolism risk increased
- multiplicative risks: including … and obesity
- Is it life-long or not?
A
- oral or transdermal oestradiol (patch/gel)
- higher doses than post-menopausal HRT
- Oestradiol is safer than ethinylestradiol or conjugated equine oestrogens
- GnRH analogue to suppress testosterone
- depot IM injection 3-monthly
- not required after gonadectomy
- Venous thromboembolism risk increased
- multiplicative risks: smoking, obesity
- Life-long treatment - do not stop at usual age of menopause
9
Q
Testosterone treatment
- Hair - is there scalp loss?
- How is testosterone administered?
- do you need a GnRH analogue?
- Risk of what? - What group of people is this risk increased?
- Maximum effect achieved after … years of treatment
A
- Hair - scalp hair loss (depending on genetic factors) and male-pattern hair growth
- Intramuscular, depot, 3-monthly injections or transdermal gel daily - standard doses
- do not need a GnRH analogue
- Risk of polycythemia - monitor haemoglobin and haematocrit - increased risk in smokers
- Maximum effect achieved after 5 years of treatment
10
Q
Sexual Health and Contraception
- trans-male:
- consider the IUD (coil) or depot progesterone if having sex with men - testosterone treatment is teratogenic
- Higher HIV prevalence in who?
A
- trans-male:
- consider the IUD (coil) or depot progesterone if having sex with men - testosterone treatment is teratogenic (may cause birth defects via a toxic effect on an embryo or fetus)
- sexual health important - including HIV screening as indicated - higher HIV prevalence in trans-females
11
Q
Screening - trans-female
- …. from age 50 once on hormone therapy for … years
- …. at 60 - measure bone mineral density and bone loss - sooner if other risk factors for osteoporosis or if inadequate hormone therapy post-gonadectomy
A
- mammography from age 50 once on hormone therapy for 5 years
- DEXA at 60 - measure bone mineral density and bone loss - sooner if other risk factors for osteoporosis or if inadequate hormone therapy post-gonadectomy
12
Q
Screening - trans-male
- … and … screening as for XX population unless …
- will not receive automated invitations for screening - chest reconstruction not a … - self-examination recommended
- consider 2-yearly USS endometrium unless removed - risk of …
- …. at 60 as for trans-females
A
-
Cervical and breast screening as for XX population unless surgically removed
- will not receive automated invitations for screening - chest reconstruction not a mastectomy - self-examination recommended
- consider 2-yearly USS endometrium unless removed - risk of hyperplasia
- DEXA at 60 as for trans-females
13
Q
Psychological care
- increased risk of what?
- has this improved?
- self-help groups?
- remember - conversations and past medical Hx - sensitive!
A
- increased risk of depression/suicide/self-harm/substance abuse
- has this improved - yes - with more acceptance in modern societies
- self-help groups - can be helpful - social isolation is often a problem
14
Q
Sub-specialist areas - transgender healthcare
-
Adolescents
- GnRH analogues can be used to delay …
- decisions about the subsequent use of hormone therapy in these patients are extremely complicated - requires specialist … approach
-
Non-binary
- is a …
- fluid/fixed
- need a specialist psychological formulation and MDT approach
- lack of evidence base for … - low dose/short-term therapy may be an option
A
-
Adolescents
- GnRH analogues can be used to delay puberty
- decisions about the subsequent use of hormone therapy in these patients are extremely complicated - requires specialist MDT approach
-
Non-binary
- spectrum
- fluid/fixed
- need a specialist psychological formulation and MDT approach
- lack of evidence base for hormone therapy - low dose/short-term therapy may be an option
15
Q
Long-term health outcomes - transgender healthcare
- beneficial effects of treatment include:
- reduced …. (depression and anxiety)
- improved … - improved sexual function and sexual functioning
- Survival data is difficult to interpret:
- Historical data may not reflect what?
- Appropriate …? (XX/XY)
- Who has more deaths from various diseases? (esp smokers)?
- CVD, stroke, venous thromboembolism, lung cancer, HIV-related deaths
A
- beneficial effects of treatment include:
- reduced psychopathology (depression and anxiety)
- improved QoL - improved sexual function and sexual functioning
- Survival data is difficult to interpret:
- Historical data may not reflect recent changes
- Appropriate comparators? (XX/XY)
- trans-female have more deaths from various diseases (esp smokers)
- CVD, stroke, venous thromboembolism, lung cancer, HIV-related deaths)
