Transgender Healthcare and Hormone Therapy

Question 1

What does transgender mean?

Answer 1

• individuals gender they were born with differ from gender they associate with
• e.g. born a boy but associate as a girl

Question 2

What is Cisgender?

Answer 2

• an individual whose gender identity and gender expression align with the sex assigned at birth
• born female and associate with female

Question 3

What is meant by gender binary?

Answer 3

• classification of genders into two discrete categories of male and female

Question 4

What is transgender congruence?

Answer 4

• feeling of harmony in our bodies
• degree to which individuals feel genuine, authentic, and comfortable within their external appearance and accept their genuine identity has been calledtransgender congruence

Question 5

What is gender identity?

Answer 5

• internal sense of being male, female or something else

- may or may not correspond to an individual’s sex assigned at birth or sex characteristics

Question 6

What is gender dysphoria?

Answer 6

• discomfort or distress related to an incongruence (mis-alignment) between an individual’s gender identity and the gender assigned at birth

Question 7

What does transition relate to in terms of sexual orientation?

Answer 7

• process of shifting towards a different gender role from one assigned at birth

Question 8

Transition in relation to sexual orientation relates to the process of shifting towards a different gender role from one assigned at birth. What are 5 of the most common things that can included in transition?

Answer 8

• social transition
• new name and identity
• new pronouns
• new clothing
• medical alterations (surgery and hormone treatment)

Question 9

What 2 things can be included in social transition?

Answer 9

• new names and pronouns

- new clothes

Question 10

What 2 things can be included in hormone transition?

Answer 10

1 - suppression of biological sex hormones

2 - transgender hormone therapy

Question 11

When providing suppression of biological sex hormones and transgender hormone therapy, is this 100% changeable?

Answer 11

• no

- 90% changeable

Question 12

Surgery is often an option for transition. Is surgery available to everyone?

Answer 12

• no
• may not want surgery
• may not be able to have surgery

Question 13

Transgender care is very complex, why is this?

Answer 13

• so many bodily systems and functions can be affected

- mental health, endocrinology, GP, surgeons are just some specialties

Question 14

What is a transgender male and female?

Answer 14

• transgender male = born a woman and transitioning into a man
• transgender female = born a man and transitioning into a woman

Question 15

A transgender female is someone who was born a man and transitioning into a woman. What 2 treatments are these patients given in the form of hormone therapy?

Answer 15

1 - exogenous estrogen to help feminise

2 - anti-androgens to suppress masculinity

Question 16

A transgender female is someone who was born a man and transitioning into a woman. These patients given 2 forms of hormone therapy:

1 - exogenous estrogen to help feminise
2 - anti-androgens to suppress masculinity

What is the intention of this hormone therapy?

Answer 16

• feminize = change fat distribution and inducing breast formation
• de-masculinity = reducing male pattern hair growth

Question 17

A transgender male is someone who was born a female and transitioning into a man. What treatments are these patients given in the form of hormone therapy?

Answer 17

1 - exogenous testosterone is provided

Question 18

A transgender male is someone who was born a female and transitioning into a man. These patients are given exogenous testosterone as part of their hormonal therapy. What is the aim of this therapy?

Answer 18

• induce virilization (females develops characteristics associated with male hormones)
• decrease femininity and increase masculinity

Question 19

Patients who are on exogenous testosterone (transgender male) or estrogen (transgender female) will have a reduction in the synthesis of endogenous androgens. Why is this?

Answer 19

• testosterone and estrogen provide negative feedback loop
• reduce gonadotrophin release hormone (GnRH) from hypothalamus
• reduce leutenising hormone (LH) and follicle stimulating hormone (FSH) from the anterior pituitary gland

Question 20

What affects can estrogen have on hair in a transgender woman?

Answer 20

• reduce some facial hair
• reduce body hair
• prevents further hair loss from scalp

Question 21

What affects can estrogen have on breasts in a transgender woman?

Answer 21

• increase breast size by one cup

- requires estrogen treatment for optimal breast development

Question 22

Estrogen can affect body hair and breast development in transgender women. Is it more effective to give large doses of estrogen or slow lifelong treatment?

Answer 22

• slow life long treatment

Question 23

Exogenous estrogen treatment is the main stay treatment for transgender women, but what are the 4 common side effects?

Answer 23

1 - vaginal bleeding
2 - bloating
3 - breast tenderness
4 - leg camps

Question 24

Exogenous estrogen treatment is the main stay treatment for transgender women, but there are 4 common side effects:

1 - vaginal bleeding
2 - bloating
3 -breast tenderness
4 - leg camps

What are 2 more serious risks associated with exogenous estrogen supplementation?

Answer 24

• breast cancer

- venous thrombo-embolism

Question 25

What affects can testosterone have on hair in a transgender men?

Answer 25

- increase body hair | - may cause hair scalp loss

Question 26

Testosterone is given to transgender men as hormonal therapy. What 2 methods are used to administered it?

Answer 26

1 - intramuscularly | 2 - transdermal gel

Question 27

Testosterone is given to transgender men as hormonal therapy. How long can it take for a maximum effect to be achieved?

Answer 27

- 5 years

Question 28

Exogenous testosterone treatment is the main stay treatment for transgender men, but what are the 3 common side effects?

Answer 28

1 - skin problems (acne, increased facial or body hair growth, male-pattern baldness 2 - increased interest in sex 3 - headache, anxiety, depressed mood

Question 29

Exogenous testosterone treatment is the main stay treatment for transgender men, but can lead to these 3 common side effects: 1 - skin problems (acne, increased facial or body hair growth, male-pattern baldness 2 - increased interest in sex 3 - headache, anxiety, depressed mood What are these patients at increased risk of?

Answer 29

- polycythemia = increase in the number of red blood cells in the body

Question 30

What are the 4 most common screenings required for transgender women (born male and transitioning into female)?

Answer 30

1 - breast screening (increased risk of breast cancer) 2- bowel cancer screening (men at increased risk) 3 - abdominal aortic aneurysm (more common in men) 4 - DEXA scan (women more susceptible)

Question 31

What are the 4 most common screenings required for transgender men (born female and transitioning into male)?

Answer 31

1 - breast screening 2 - bowel cancer screening 3 - cervical screening 4 - DEXA scan (women more susceptible)

Question 32

Patients who are undergoing transition are more at risk of what psychological problems?

Answer 32

- depression - suicide - self-harm - substance abuse

Question 33

Patients who are undergoing transition are more at risk: - depression - suicide - self-harm - substance abuse What else can this group of patients be, and what can be a useful treatment option for them?

Answer 33

- loneliness | - self help groups can be useful

Question 34

What are the 3 major long term advantages that a patient undergoing transition may experience?

Answer 34

1 - reduced gender dysphoria 2 - reduced psychopathology (anxiety and depression) 3 - improved quality of life (sexual and social functioning)

Question 35

What are the major long term disadvantages for a patient undergoing transition?

Answer 35

- increased levels of self harm and suicide

Question 36

The major long term disadvantages for a patient undergoing transition is the increased levels of self harm and suicide. in addition, transgender females (born male and transitioning to females) are more likely to die from 4 key causes which is made worse by smoking, what are they?

Answer 36

1 - cardiovascular disease & stroke 2 - venous thromboembolism 3 - lung cancer 4 - HIV-related deaths