Transgender pt Flashcards
transgender
individuals who do not conform to the gender norms of their natal sex (assigned gender).
cisgender
individuals whose gender identity is consistent with their natal sex (assigned gender).
natal sex
the sex of an individual at the time of birth.
gender identity
the gender an individual identifies as regardless of their natal sex (assigned gender).
male female both or neither
transexual
diagnostic term- person who wants to live as opposite of their birth assigned sex and seeks medical treatment to make their body congruent with their identity through hormones and/or surgery.
gender expression
How a person expresses their gender through the way they behave, hair style, the way they dress, etc.
gender variant/non-conforming def
When a person’s gender expression is different from societal norms
sexual orientation
How a person identifies their physical and emotional attraction to others
Gender identity does not equal ___________
sexual orientation
intersex
Person born with sexual or reproductive anatomy that is not typical for either male or female
pansexual
Person who is attracted to any genders, not limited to the male-female binary
Terms not used
Transvestite-
Tranny-
Hermaphodite-
transvestite- cross dress
tranny- derogatory transgender
hermaphordite- intersex
Gender dysphoria in children DSM V criteria
strong incongruence between one’s experienced/expressed gender and their assigned gender and this must be at least 6 months in length**
6 of following:
desire to be other gender, cross dress, role play other gender, toys/games other gender, playmates of opposite sex, rejection of toys from assigned gender, dislike of anatomy, sex characteristics
impairs functioning
Gender dysphoria adults and adolescents criteria dx
incongruence x 6 months
+2 of these: incongruence, desire to rid sex organs, get other gender sex characteristics, be other gender, to be treated as other gender, reactions/feelings of other gender
Posttransition definition
full time living in new gender plus one sex reassignment surgery
gender affirmation def.
process of gender change
- coming out
- changing pronoun, -hormones
- legal changes
WPATH standards of care
assessment of children mental health hormones voice/communication therapy surgery life long prevention primary care
children with dysphoria vs adolescent…will they transition later in life?
children- many do not go on to be trans
adolescent- majority will
standard of care for children with dysphoria
no changes until ______
length of time before initiation_______
- no changes until evaluated by mental health
- no set length of time to be in therapy before initiation
hormone to prevent puberty
used until age____
fertility?
gonadotropin-releasing hormone (leuprolide acetate IM monthly)
used until legal age to decide if want gender affirming hormones or surgery
does not effect fertility
Labs/dx for suppression of puberty
q 3 months
q year
q 3 mos: height* weight tanner + LH FSH estradiol/testosterone
q year: renal, lipids, liver, glucose, hemoglobin
bone density, bone age
when to begin suppression of puberty
tanner stage 2
criteria for hormone therapy for gender affirmation
-documented_____
-can make_____
-
-control of?
- persistent, documented dysphoria
- can make informed decision
- age of majority
- if medical or psych issues must be controlled
Hormone targets for:
transgender male
transgender female
(FTM)- testosterone target (300-1,000)
MTF- decrease testosterone promote levels of estradiol (>200) with anti-androgen and estrogen
Risk of feminizing hormones
likely
likely with factors
possible
no risk
likely: thrombo, gallstrones, elevated LFT, weight gain, high triglycerides
likely with factors: cardiovascular
possible risk- diabetes type II
no risk- breast cancer
Risk of masculinizing hormones
likely
possible risk
no risk
likely- polycythemia, weight gain, acne, androgenic alopecia, sleep apnea
possible- destabilization (cardio, HTN, type II diabetes)
no risk: bone density, reproductive cancers
Baseline labs before initiating hormones (not hormones)
Trans men:
Transwomen:
Transmen: hgb, lipids
Transwomen: lipids, electrolyte, renal, ?liver
FtM hormones available in what forms and how often given?
Depo-testosterone, delatestryl q week x 1 month adjust to suppress period and create male characteristics
androgel, androderm (patch) start 2.5
FTM monitoring
follow up at what intervals?
labs - target level, other
screening
1 month, 3, 6, then q 6-12
testosterone (300-1000) peak level 1-2d after injection, trough-before
Hct, lipid
BMD (screening for those at risk or 10 years after starting hormone)
Chest/axillae- increased risk breast CA (compared to natal males)
Characteristics that are not reversible in FTM after hormones
clitoral enlargement, voice, scalp loss
hormones MTF
Two types and examples for each
1) -
-
2) -
-
-
Estrogen
1) dermal 2x/wk if >40 y or
risk for DVT
2) oral estrace if <40 and low risk DVT
Androgen antagonist
1) Aldactone 2) Proscar 3) Androcur
aldactone considerations
if on ACEI- max 25 mg and monitor K+
if renal insufficiency- start at 50 increase by 50 q week- renal function testing with each increased dose
monitor mtf
follow up intervals
labs- hormones, other
screening
PSA?
1 mo, 3, 6, then q6-12
testosterone (30-100) E2 <200 prolactin q 1-2 y potassium screen breast and prostate cancer (no PSA, estradiol makes it low)
Breast cancer risk
Transwomen (no hormones)
Transwomen (hormones)
Transmen (no surgery)
Transmen (surgery)
TW no hormone- no increased risk
TW on hormones- lower risk than females, but higher than other males
TM no surgery- tx like female
TM top surgery- reduced risk, higher than males
cervical cancer screening
transwomen
transgender men
transwomen- who had vaginoplasty may have risk of condyloma consider screening
transgender men- not at increased risk, q3-5y, will have atrophy
transmen after hysterectomy
cervical ca screening
after hysterectomy- no paps
if no history of high grade dysplasia
if hx high grade- follow by gyn and onc
can do a total hysterectomy if meet these three criteria:
- no desire for pregnancy
- older than 40
- surgery will do no harm
transmen have higher risk of:
PCOS (screen at least once)
chance of infertility, cardiac, HTN, endometrial cancer
Prostate screening
transwomen no hormones
transwomen hormones
no hormones- PSA if high risk (AA) family hx (start at 45-50)
hormones- decreased risk prostate cancer, prostate is not removed must start digital exam 50
Health screenings for hormones 1) 2) 3) 4) 5)
cardiac- hormones, smokers, PCOS
lipids- testosterone
HTN- estrogen increases, testosterone unknown
DM- estrogen increases risk, PCOS (glucose intolerance) testosterone- decreased fat and glucose, increase insulin resistance
yearly screening
lipids- estrogen (inc HDL and triglycerides; decreased LDL) testosterone (decrease HDL increase LDL)
osteoporosis- estrogen good, transmen after ovary removal bone density decrease if testosterone not replaced properly to prevent LH
transwomen with hyperlipidemia should use___
transdermal estrogen patch
Conceiving after hormone
FTM
MTF
FTM- may be able to
MTF- sterile within a few months
chest surgery criteria required prerequisite
MTF should take _______ prior to breast surgery
one referral mental health provider, hormone not prerequisite
-MTF should take feminizing hormone to increase breast tissue
genital surgery criteria:
1) removal of sex organs:
2) rearranging surgery:
two mental health provider referals
removal of sex organs- 12 months continuous hormones
rearranging surgery- also 12 months living in gender full time
MTF post surgical considerations
1)
2)
3)
4) pap?
intercourse or dilation of vagina
UTI
incontinence from nerve damage
pap if glans penis used to create cervix
if no new cervix- pap if history of genital warts
FTM pap?
many will not have vaginectomy
atrophy because of testosterone- painful
