12.2 Transgender Health

Question 1

What is the definition of transgender?

Answer 1

A word used to describe someone whose gender identity does not correspond with the sex that they were assigned at birth

Question 2

What is the definition of a cisgender man?

Answer 2

• If you were born with a penis and identify as a man
• Can be sexually attracted to men & women etc

Question 3

What is the definition of a cisgender woman?

Answer 3

• If you were born with a vagina and identify as a woman
• Can be attracted men & women etc

Question 4

What is the definition of a transgender man?

Answer 4

A trans man is a man who was assigned female at birth

Question 5

What is the definition of a trangender woman?

Answer 5

A trans woman is a woman who was assigned male at birth

Question 6

What is the definition of a non-binary person?

Answer 6

• Nonbinary gender is an umbrella term to describe any gender identity that does not fit into the gender binary of male* and *female (not entirely male or female)
• Need to use the pronouns they, them, theirs

Question 7

What is the definition of androgynous?

Answer 7

Identifying and/or as neither specifically masculine or feminine

Question 8

What is the definition of gender fluid?

Answer 8

One who embraces fluidity of gender identity

Question 9

What is the definition of agender?

Answer 9

One who does not ideentify as a particular gender

Question 10

What is the definition of gender non-conforming?

Answer 10

One whose physical or behavioural characteristics do not correspond to the traditional expectations of their gender

Question 11

What is the definition of genderqueer?

Answer 11

One who does not identify with a single fixed gender

Question 12

What is the definition of bigender?

Answer 12

Identifying as two genders

Question 13

What is definition of trigender?

Answer 13

Identifying as 3 genders

Question 14

What is the definition of neutrois?

Answer 14

Gender neutral

Question 15

What is the definition of a demigirl & demiguy?

Answer 15

DEMIGIRL

Identifying particularly as a girl but not wholly

DEMIGUY

Identifying particularly as a guy but not wholly

Question 16

What is the definition of cisgender?

Answer 16

Identifying as the gender you were assigned to at birth

Question 17

Explain the minority stress theory

Answer 17

Question 18

Explain mental health in trans people

Answer 18

• Almost half of trans people have attempted suicide at least once
• More than half are diagnosed with depression
• Thus, are more at risk of:
  
  • Threats
  • Violence
  • Alcohol/substance abuse
  • Stress
  • Anxiety
  • Delayed cancer diagnosis

Question 19

Explain the short term & long term management of mental health (depression) in trans people

Answer 19

Question 20

Explain the trouble of being referred to a NHS gender identity clinic & what happens following referral

Answer 20

• Waiting times are VERY LONG
  
  • Can be at least 100 weeks long in some clinics
• Be helpful to dictate the letter with the person in the room to check if they are OK with the language being used

Question 21

What kind of transitions can be done to a trans person?

Answer 21

• Social Transition
• Medical Transition (Hormones)
• Surgical Transition
• Electrolysis/Laser (hair removal)
• Speech and Language Therapy
• Gamete Storage (10 years)
• Psychology

Question 22

What kind of hormonal help can trans people get & why?

Answer 22

• ​Bridging prescriptions (so don’t self-medicate from un-regulated sources)
• AFAB (assigned female at birth)
  
  • +/- anti-androgen (usually GNRH analogue)
  • Testosterone
• AMAB (assigned male at birth)
  
  • Estradiol
  • +/- anti-androgen (usually GNRH analogue)

Question 23

What kind of surgery can trans people get?

Answer 23

AFAB (assigned female at birth)

• “Top surgery” - Bilateral mastectomy with male chest reconstruction
• “Lower surgery” - phalloplasty or metoidioplasty; scrotoplasty; Hysterectomy

AMAB (assigned male at birth)

• “Lower surgery” - Orchiectomy, Penectomy, Vaginoplasty, Vulvoplasty
• Laryngeal surgery
• Facial feminisation surgery
• Breast augmentation

Question 24

Where should a trans person be nursed?

Answer 24

• Transgender patients should be nursed according to their full-time gender expression and not according to their sex assigned at birth
• They should be asked if they would like a side room for increased privacy if possible
• Medical staff must be careful to maintain their privacy
• Using appropriate pronouns* and the *patient’s preferred name (even if this does not match the name on the medical records) is very important

Question 25

What is the risk of having a **trans person** on **estradiol**?

Answer 25

* There's a **high** risk of a _venous thromboembolism_ * If there is high risk switching to *transdermal* estradiol is advisd (LOWER risk of VTE) * Seek help from *_gender identiy clinic_* or *_endocrinologist_* * **Hypertriglyceridaemia** * Increase triglycerides = increased risk atherosclerosis & diabetes (**Type II**) * **Hypertension**

Question 26

What are the effects of **estradiol** on a trans woman?

Answer 26

* Breast growth * Body fat moves generally from *tummy* to **hips** and **thighs** * _Less_ *muscle bulk* and _less_ *strength* * Less hair on *body* and *face* * Stop losing more hair from your *head* (please note: scalp hair that has already been lost does not grow back) * Softer skin and less oiliness of your skin * *Smaller* testicles * Fewer sperm are produced - affects *fertility* * *_Lower_* libido (less interest in sex) * _Difficulty_ in achieving an *erection* for use in sexual activity * _Fewer_ erections when not involved in sexual activity * _Reduced_ level of *haemoglobin* (Oxygen-carrying pigment in red blood cells)

Question 27

What are the effects of **testosterone** treatment (hormone) on **trans males**?

Answer 27

* Body fat moves generally from *hips* and *thighs* to **tummy** * Increase in size and strength of *muscles* * Increase in amount and thickness of *hair* on body * Increase in *_amount_* and *_thickness_* of *facial* *hair* * Oilier skin and acne (spots on face, neck and back) * Voice *_deepens_* * More red blood cells are made * *Menstrual period bleeding stops* * Clitoris *growth* (on average by about 1-3 cm) * *Increased sex drive* * Vaginal *dryness* and thinning of vaginal walls * *Head hair loss*

Question 28

What is the risk of having a **trans male** on **testosterone**?

Answer 28

* **Polycythaemia** * Increase amount of RBC can cause INCREASE risk of clots * **Hyperlipidaemia** (INCREASE in liver enzymes) * Can lead to **Type II diabetes** * **Hypertension** * **Cardiovascular disease**

Question 29

What tests would you do on **monitoring** a **trans person**?

Answer 29

* **Blood pressure** * **Blood tests** * FBC * U&Es * LFT * Fasting blood glucose/HbA1C * Lipid profile * TFTs * Serum Testosterone * Serum Estradiol * Prolactin * LH * FSH Every **4** months till a year Every **6** months for next **3** years Then **annually**

Question 30

What is a **GNRH analogue** & what are the **side effects**?

Answer 30

Hormones – GNRH Analogue * Reduce *_endogenous_* sex hormone production (oestrogen/testosterone) * Generally *safe* and *well tolerated* in transgender patients as we are *_replacing_* their sex hormones * When used in cisgender patients side effects could include *osteoporosis*, *hot flushes*, *excessive sweating* (especially at night) **_Side Effects_** * Injection site reactions (redness, swelling) * Headaches, dizziness or nausea (sickness) * Mood changes * Lower energy levels * Loss of libido (interest in sex) * Joint or muscle pain | (**IM injection/SC implant**)

Question 31

Explain screening in the **transgender** population

Answer 31

* For **non-binary** patients * **​**Consider what *_organs_* patient has * If patient _no_ longer wants to be invited to screening they can **opt out** **Cervical Cancer** (screening) * _NOT_ required for *_trans men_* that had *_total hysterectomy_* (is the surgical removal of the uterus and other female structures) * *_Trans men_* with a *cervix* offered screening at the same frequency as *cisgender women* * *_Trans women_* _do not_ need screening as they _do not_ have a *cervix* *​***Breast cancer** (screening) * *Transgender men* aged 50-70 should have breast screening if they *still* have *breast tissue* (if they have had chest masculinising surgery they may not have enough breast tissue to effectively screen but should still be chest aware) * *Transgender women* aged 50-70 should be *invited* to have breast screening * Hormone treatment - *increased risk of breast cancer* in trans women compared with cisgender men, and a lower *risk in trans men* compared with cisgender women **AAA** (screaning) * *Transgender women* aged 65 should *have* screening for a AAA * *Transgender men* _do not_ require screening