Vulnerable Populations Flashcards
How often should patients on feminizing hormones be monitored?
Baseline, three months, six months, and yearly
What are some possible contraindications to estrogen therapy?
Unstable ischemic CVD disease, estrogen dependent cancers, end stage chronic liver disease, psychiatric conditions that limit ability to provide informed consent, hypersensitivity/allergy
When should discontinuation of hormone therapy be considered?
Fertility preservation, pregnancy, surgery, old age, health issues, financial, need to change gender presentation
For a 23 year old female newly arriving from the Caribbean, what vaccinations should be provided?
HPV, DPT, varicella, MMR
What are some reversible changes of feminizing hormone therapy?
Reduction in muscle mass, reduction of body/facial hair, changes to skin/sweat, changes to body fat distribution, changes to libido
What are some irreversible changes with feminizing hormone therapy?
Reduced testicular and prostatic size, sperm count reduction, breast development
What are the two anti-androgens used with feminizing therapy and what are the typical doses?
Spironolactone 50 mg daily-BID (usual dose 100 mg BID, max 150 mg) and cyproterone 12.5 mg q2d-daily (usual 25 mg daily, max 50 mg)
What routes of administration can occur with feminizing hormone therapy?
Oral anti-androgen, oral or transdermal (gel/patch) estrogen
What is the typical dose of oral estrogen for feminizing hormone therapy?
1-2 mg daily with usual dose of 4mg daily or 2 mg BID
What are some limitations of estrogen for feminizing hormone therapy?
Does not affect the pitch of the voice, does not eliminate facial or neck hair, does not have significant impact on breast growth
What are some reversible changes of masculinizing hormone therapy?
Fat redistribution, increased muscle mass, cessation of menses, hair growth
What are some irreversible changes of masculinizing hormone therapy?
Clitoral growth, voice changes
When is the cessation of menses generally achieved with masculinizing therapy?
Within 3-6 months
What is the route of administration of testosterone and the usual dose?
Injection 20-50 mg IM/SC weekly (max 100 mg) or transdermal (patch or gel)
What are contraindications to testosterone therapy?
Pregnancy/breastfeeding, active/known hormone-sensitive cancer, unstable CVD disease, poorly controlled psychosis, psychiatric conditions that limit ability to provide informed consent, hypersensitivity/allergy
