Week 3: Transgendered Clients as Patients

Question 1

Gender identity

Answer 1

how a person internally identifies - can be different than what a patient is assigned at birth

Question 2

Gender expression

Answer 2

Outward expression of a patient’s identity - can be fluid for some people

Question 3

Sex assigned at birth

Answer 3

based on external genatalia

Question 4

Gender dysphoria

Answer 4

internal sense of conflict between one’s gender identity and the assigned sex at birth

Question 5

Cisgender

Answer 5

gender identity is congruent with the sex assigned at birth

Question 6

Transgender male

Answer 6

male identified person who was assigned female at birth

Question 7

Transgender female

Answer 7

female identified person who was assigned male at birth

Question 8

Medications used for transgender female adults

Answer 8

• estrogen therapy - 17 beta-estradiol is generally recommended
• Spironolactone - antiandrogen that counteracts testosterone
• Alpha-5 reductase inhibitors (finasteride) - used for male pattern loss

Question 9

Effects of estrogen therapy in transfeminine adults - gender affirming effects

Answer 9

• decreased sexual desire
• decreased spontaneous erections
• redistribution of facial and body fat
• decreased muscle mass/strength
• softening of skin/decreased oiliness
• breast growth (irreversible)
• decreased testicular volume (irreversible)
• decreased sperm production (irreversible)
• decrease in erectile function
• slowed growth of body/facial hair
• Unchanged: vocal pitch, Adam’s apple, already-established facial/body hair

Question 10

Medications used for transgender male adults

Answer 10

• testosterone therapy - injected, gel, patches, oral tablets, implanted pellets
• Testosterone cypionate is most widely used
• *oral not recommended due to hepatotoxicity**

Question 11

testosterone treatment in transmasculine adult patients changes

Answer 11

• Clitoral enlargement (irreversible)
• voice deepening (irreversible)
• Vaginal atrophy (irreversible)
• facial/body hair growth (irreversible)
• scalp hair loss (irreversible)
• to achieve gender-affirming secondary sex characteristics - deeper voice, amenorrhea
• redistribution of facial and body fat
• increased skin oiliness/acne
• increase in muscle mass/strength
• cessation of menses

Question 12

Risks of testosterone therapy in transmasculine adult patients

Answer 12

• erythrocytosis
• androgenetic alopecia/male pattern baldness
• worsening migraines
• increase hematocrit = thrombosis, hemorrhage

Question 13

Pharmacological therapy for menstrual cessation in transmasculine adults

Answer 13

• levonorgestrel IUD (Mirena, Skyla)
• Depot medroxyprogesterone acetate (Depo-Provera)
• Etonogestrel implant (Nexplanon)
• Danazol synthetic androgen