Transgender Healthcare and Hormone Therapy Flashcards
What does transgender mean?
- individuals gender they were born with differ from gender they associate with
- e.g. born a boy but associate as a girl
What is Cisgender?
- an individual whose gender identity and gender expression align with the sex assigned at birth
- born female and associate with female
What is meant by gender binary?
- classification of genders into two discrete categories of male and female
What is transgender congruence?
- 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
What is gender identity?
- 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
What is gender dysphoria?
- discomfort or distress related to an incongruence (mis-alignment) between an individual’s gender identity and the gender assigned at birth
What does transition relate to in terms of sexual orientation?
- process of shifting towards a different gender role from one assigned at birth
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?
- social transition
- new name and identity
- new pronouns
- new clothing
- medical alterations (surgery and hormone treatment)
What 2 things can be included in social transition?
- new names and pronouns
- new clothes
What 2 things can be included in hormone transition?
1 - suppression of biological sex hormones
2 - transgender hormone therapy
When providing suppression of biological sex hormones and transgender hormone therapy, is this 100% changeable?
- no
- 90% changeable
Surgery is often an option for transition. Is surgery available to everyone?
- no
- may not want surgery
- may not be able to have surgery
Transgender care is very complex, why is this?
- so many bodily systems and functions can be affected
- mental health, endocrinology, GP, surgeons are just some specialties
What is a transgender male and female?
- transgender male = born a woman and transitioning into a man
- transgender female = born a man and transitioning into a woman
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?
1 - exogenous estrogen to help feminise
2 - anti-androgens to suppress masculinity
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?
- feminize = change fat distribution and inducing breast formation
- de-masculinity = reducing male pattern hair growth
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?
1 - exogenous testosterone is provided
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?
- induce virilization (females develops characteristics associated with male hormones)
- decrease femininity and increase masculinity
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?
- 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
What affects can estrogen have on hair in a transgender woman?
- reduce some facial hair
- reduce body hair
- prevents further hair loss from scalp
What affects can estrogen have on breasts in a transgender woman?
- increase breast size by one cup
- requires estrogen treatment for optimal breast development
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?
- slow life long treatment
Exogenous estrogen treatment is the main stay treatment for transgender women, but what are the 4 common side effects?
1 - vaginal bleeding
2 - bloating
3 - breast tenderness
4 - leg camps
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?
- breast cancer
- venous thrombo-embolism
What affects can testosterone have on hair in a transgender men?
- increase body hair
- may cause hair scalp loss
Testosterone is given to transgender men as hormonal therapy. What 2 methods are used to administered it?
1 - intramuscularly
2 - transdermal gel
Testosterone is given to transgender men as hormonal therapy. How long can it take for a maximum effect to be achieved?
- 5 years
Exogenous testosterone treatment is the main stay treatment for transgender men, but what are the 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
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?
- polycythemia = increase in the number of red blood cells in the body
What are the 4 most common screenings required for transgender women (born male and transitioning into female)?
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)
What are the 4 most common screenings required for transgender men (born female and transitioning into male)?
1 - breast screening
2 - bowel cancer screening
3 - cervical screening
4 - DEXA scan (women more susceptible)
Patients who are undergoing transition are more at risk of what psychological problems?
- depression
- suicide
- self-harm
- substance abuse
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?
- loneliness
- self help groups can be useful
What are the 3 major long term advantages that a patient undergoing transition may experience?
1 - reduced gender dysphoria
2 - reduced psychopathology (anxiety and depression)
3 - improved quality of life (sexual and social functioning)
What are the major long term disadvantages for a patient undergoing transition?
- increased levels of self harm and suicide
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?
1 - cardiovascular disease & stroke
2 - venous thromboembolism
3 - lung cancer
4 - HIV-related deaths
