Transgender pt Flashcards by Katherine Lee

transgender

individuals who do not conform to the gender norms of their natal sex (assigned gender).

How well did you know this?

Not at all

Perfectly

cisgender

individuals whose gender identity is consistent with their natal sex (assigned gender).

How well did you know this?

Not at all

Perfectly

natal sex

the sex of an individual at the time of birth.

How well did you know this?

Not at all

Perfectly

gender identity

the gender an individual identifies as regardless of their natal sex (assigned gender).

male female both or neither

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

gender expression

How a person expresses their gender through the way they behave, hair style, the way they dress, etc.

How well did you know this?

Not at all

Perfectly

gender variant/non-conforming def

When a person’s gender expression is different from societal norms

How well did you know this?

Not at all

Perfectly

sexual orientation

How a person identifies their physical and emotional attraction to others

How well did you know this?

Not at all

Perfectly

Gender identity does not equal ___________

sexual orientation

How well did you know this?

Not at all

Perfectly

intersex

Person born with sexual or reproductive anatomy that is not typical for either male or female

How well did you know this?

Not at all

Perfectly

pansexual

Person who is attracted to any genders, not limited to the male-female binary

How well did you know this?

Not at all

Perfectly

Terms not used

Transvestite-
Tranny-
Hermaphodite-

transvestite- cross dress
tranny- derogatory transgender
hermaphordite- intersex

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Posttransition definition

full time living in new gender plus one sex reassignment surgery

How well did you know this?

Not at all

Perfectly

gender affirmation def.

process of gender change

coming out
changing pronoun, -hormones
legal changes

How well did you know this?

Not at all

Perfectly

WPATH standards of care

assessment of children 
mental health
hormones 
voice/communication therapy
surgery
life long prevention primary care

How well did you know this?

Not at all

Perfectly

children with dysphoria vs adolescent…will they transition later in life?

children- many do not go on to be trans

adolescent- majority will

How well did you know this?

Not at all

Perfectly

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