Woods: Transgender Health Flashcards
What is sexual orientation?
Individual’s attraction to the same or opposite sex (sexual preference)
What is gender?
Internal sense of being male/female/other
other= on the continuum between M and F
Define transgender
self identity that doesn’t conform to one’s physical gender
Define transsexual
a person who has undergone tx to become recognizable as opposite sex
Define gender non-conforming
not corresponding to usual M/F identity of that culture
What is gender dysphoria?
Mismatch between biologic self and gender identity and the STRESS that conflict causes
Tx: reduce distress–counseling, hormones, surgery (varies for each individual)
*DSM dx
High rates of anxiety and depression in transgender individuals is related to….
minority stress NOT being transgender
*54% transgender youth attempt suicide
What does gender identity develop?
early childhood
T or F. Most gender dysphoria experienced in childhood resolves in adult.
T
*100% persistence when onset is in adolescence
When do gender dysphoria sxs present in childhood?
Age 2
Can be associated w/ anxiety, depression, autism in children
Usually resolves in puberty
When does gender dysphoria present in adolescence?
body aversion increases as secondary sex characteristics develop
How do you tx children w/ gender dysphoria?
No evidence based guidelines on when to seek medical treatments
What is pubertal suppression?
fully reversible
delays development of secondary sex characteristics (breast development, voice change, pubic hair)
Provides time to explore gender identity before permanent changes of native hormones occur
What medication is used for pubertal suppression?
M–>F: GnRH analogues or progresterone to suppress pituitary hormones and testosterone production
F->M: GnRH Analogues
Early use averts social and emotional consequences
What complications are associated w/ pubertal suppression?
decreased bone mineral density/height
decreased development of penile tissue for vaginoplasty
What are some fertility complications with pubertal suppression?
Pubertal suppression does not allow sperm banking/ova harvesting
What are barriers to hormone therapy?
50% of TG individuals attain hormones illegally
lack of insurance, providers, willing to prescribe
Before providing hormone therapy…
Mental health dx must be made
Pt must provide consent to tx
mental health issues must be addressed
What is the “real life experience” criteria?
pt must have lived as desired gender openly for 12 mos; real life experience
Tests ability to fxn in job, family, relationships
M to F Hormone therapy
Estrogen + androgen inhibitor
Individual response onset of change 3-6 mos max effect 6 mos-2 yrs estrogen pills/patch, injections spironolactone (antihypertensive that has antiandrogenic properties--widely used)
What are adverse effects of M to F HT?
decreased libido, erectile fxn, muscle fass
When is estrogen therapy contraindicated?
Hx of DVT
estrogen dependent neoplasm
end stage liver disease
What are impt things to monitor in a pt on HT therapy?
prolactin
liver fxn
bp
What is an antiandrogen?
spironolactone
blocks testosterone receptor
What is the most effective androgen suppressors?
GnRH suppress FSH and LH but are expensive
Cyproterone- progestin, not available in US
5 alpha reductase inhibitors
What are risks of F to M HT?
weight gain acne polycythemia alopecia hyperlipidemia CVD HTN
medroxyprogesterone to inhibit menses
What percent of pts undergo sexual reassignment surgery?
1/3
Does the ACA require coverage for transgender therapy?
YES but providers are often not available and are “out of network”
Define intersex
variation in sex determination
check baby’s genitalia thoroughly
You deliver a baby w/ cloacal extrophy what should you do?
consult, image, explain
You are going to do a PAP on a 22 y/o who dressses male and considers herself male and wants to be called a male name. A year ago the PAP showed ASCUS w/ HPV high risk. You should:
State you hear his request and explain how guidelines still reflect that a PAP is indicated
