Transgender Medicine

Question 1

What is the definition of transsexualism?

Answer 1

A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with or inappropriateness of one’s anatomical sex and a wish to have treatment to make one’s body as congruent as possible to one’s preferred sex

Question 2

What is the definition of dual-role transvestism?

Answer 2

The wearing of clothes of the opposite sex for part of the individual’s existence in order to enjoy the temporary experience of membership of the opposite sex but without any desire for a more permanent sex change or associated surgical reassignment and without sexual excitement accompanying the cross-dressing

Question 3

What is the definition of fetishistic transvestism?

Answer 3

The wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex - it has a clear association with sexual arousal and a strong desire to remove the clothing once orgasm occurs and sexual arousal declines

Question 4

What is gender identity disorder of childhood?

Answer 4

A disorder with usually manifests during early childhood and always well before puberty that is characterised by persistent and intense distress about the assigned sex, together with a desire to be or an insistence that one is of the other sex

Question 5

Before undergoing hormonal treatment, transgender patients may undergo fertility preservation. What does this involve?

Answer 5

The collection and storage of either oocytes or sperm

Question 6

What are the qualifying criteria for hormone therapy in transgender patients?

Answer 6

Well-documented gender dysphoria
Capacity to make a fully informed decision and consent to treatment
Age of majority
Significant medical/mental health concerns reasonably well-controlled

Question 7

GnRH analogues are given to transgender patients in order to…?

Answer 7

Suspend pubertal development of secondary sex characteristics

Question 8

What hormonal treatment suspends facial hair growth, voice changes, Adam’s apple formation and male skeletal, facial and musculature changes in trans patients?

Answer 8

AMAB

Question 9

What hormonal treatment stops periods and halts breast growth in trans patients?

Answer 9

AFAB

Question 10

At what age can surgery be undertaken for transgender patients?

Answer 10

18

Question 11

What drug is given as the initial hormonal treatment for transmen?

Answer 11

Sustanon

Question 12

If testosterone alone does not suppress menstruation, what other drugs can be given to transmen?

Answer 12

Deep provera

GnRH analogues such as triptorelin

Question 13

If a transman is sexually active with a male partner then testosterone alone is sufficient for contraception. T/F?

Answer 13

False - progesterone is required by deep proverb, implant or IUS

Question 14

What effect does testosterone hormonal treatment have an transmen?

Answer 14

Lowers voice
Increases facial and body hair growth
Increases muscle bulk
Amenorrhea
Clotoromegaly
Increased libido
Agression

Question 15

What side effects can hormonal treatments have on transmen?

Answer 15

Polycythaemia
Liver dysfunction
Increased risk of cardiovascular disease
Increased weight
Diabetes
Mental health disturbances

Question 16

Oestradiol valerate is taken as a hormonal treatment for transwomen at what dose initially?

Answer 16

1-2mg

Question 17

What drugs can be used by transwomen as anti-androgens?

Answer 17

Triptorelin
Cyproterone acetate
spironolactone

Question 18

What are the effects of hormonal treatment on transwomen?

Answer 18

Breast growth
Softer skin
Less facial and body hair
Fat redistribution to hips
Increased emotions

Question 19

What are the potential side effects of hormonal treatment for transwomen?

Answer 19

Increased risk for venous thromboembolism and breast cancer
increased weight
increased blood pressure
migraines

Question 20

What surgeries can be undertaken by transmen?

Answer 20

bilateral mastectomy
hysterectomy
oophorectomy
metoidioplasty
phalloplasty

Question 21

What are the potential adverse effects of surgery for transmen?

Answer 21

Neo-urethral stenosis
Urethral fistulas
Dislodgement
Erectile cylinders
Mechanical failure of erectile mechanism

Question 22

Do transmen need to be on the SCCRS for cervical smears?

Answer 22

Only if they have not had a hysterectomy

Question 23

What surgeries can be undertaken by transwomen?

Answer 23

Thyroid chondroplasty
Penectomy
Orchidectomy
Clitiroplasty
Vulvoplasty
Penile inversion Vaginoplasty
Colovaginoplasty
Breast augmentation

Question 24

What are the potential adverse effects of surgery for transwomen?

Answer 24

Urinary spraying
Increased risk of UTIs
Granulation tissue formation
Neovaginal hair growth
Neovaginal structure
Vascular occlusion of arterial supply to neoclitoris
Ongoing need for dilation

Question 25

Are transwomen given screening tests for cervical cancer prostate cancer or breast cancer?

Answer 25

Only for prostate and breast cancer

Question 26

What is the normal hormone level of testosterone in transmen?

Answer 26

8-15nmol/l

Question 27

What is the normal hormone level of estradiol in transwomen?

Answer 27

200-600pmol/l