Care of Transgender and Gender Diverse Clients

Question 1

describe gender dysphoria

Answer 1

discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth

Question 2

Transsexual, transgender, and gender nonconforming individuals are not inherently “disordered”, rather the _______________, when present, is the concern that might be diagnosable and for which various tx options are available

Answer 2

distress of gender dysphoria

Question 3

list 3 treatment options for patients with gender dysphoria

Answer 3

changes in gender expression
endocrine therapy to feminize or masculinize the body (gender affirming hormone therapy)
surgery
psycho/social therapy
voice and communication therapy
lifelong preventative and primary care

Question 4

_____ and _____ increases risks associated with endocrine therapy

Answer 4

smoking and obesity

Question 5

in males, estrogen reduces ____________ and ______/ ____ in a cumulative, dose dependent manner

Answer 5

testicular volume
reduces motility and density

Question 6

Males: estrogens reduce testicular volume and reduce motility and density in a __________________
1. cumulative, nondose dependent
2. cumulative, dose dependent
3. noncumulative, nondose dependent
4. noncumulative, dose dependent

Answer 6

cumulative, dose dependent manner

Question 7

what is the first line treatment for gender dysphoria in adolescents

Answer 7

leuprolide

Question 8

what is a reversible emans of suppressing unwanted irreversible body chages

Answer 8

leuprolide

Question 9

whawt is leuprolide? how does it work?

Answer 9

GnRH agonist
causes receptor downregulation = suppresses release of FSH and LH

Question 10

AEs of leuprolide

Answer 10

painful injections, hot flashes, low mood/ fatigue, loss of bone mineral density

Question 11

Feminizing GAHT includes 3 options

Answer 11

estrogens
antiandrogen / blockers
progestins

Question 12

antiandrogens/ blockers are for (3 populations)

Answer 12

adults with testes
youth not on GnRHa
when the client’s goal is to approximate cisgender hormones

Question 13

what options are there for masculine GAHT

Answer 13

testosterone +/- blockers

Question 14

list the 3 irreversible changes of feminizing GAHT

Answer 14

breast development
possible loss of fertility
possible decreased adult height (if E started before completed skeletal growth)

Question 15

list the 3 reversible changes of feminizing GAHT

Answer 15

thinning of body hair and skin softening
fat redistribution
decreased libido and erections

Question 16

what types of estrogen are there for GAHT

Answer 16

estradiol oral
estradiol transdermal
compounded estradiol valerate or cypionate

Question 17

what is the most commonly prescribed estrogen for GAHT

Answer 17

estradiol oral

Question 18

estradiol transdermal is recommended for

Answer 18

trans women >45yrs, hx VTE, tobacco use, BMI =>27, post op status

Question 19

AEs of estrogens in GAHT

Answer 19

weight gain, HPTN, hypertriglyceridemia, VTE, ED, infertility, RFs (CVD, cholelithiasis, T2D, hyperprolactinemia)

Question 20

antiandrogens minimize the _____ needed to suppress T

Answer 20

dose of E

Question 21

what feminizing effects do antiandrogens have?

Answer 21

breast development and reduction in androgen sensitive face and body hair (if prevented before it starts in puberty, don’t need removal later)

Question 22

how does spironolactone act as an antiaandrogen

Answer 22

blocks peripheral androgen receptors- will not always affect a significant change in blood T levels

Question 23

spironolactone AEs

Answer 23

hyperkalemia, dizziness, GI distress

Question 24

which 2 antiandrogens are used for GAHT

Answer 24

spironolactone, cyproterone

Question 25

which has more rapid suppress of T
1. spironolactone
2. cyproterone

Answer 25

2

Question 26

cyproterone MOA

Answer 26

Androgen receptor blockade, also inhibits production of LH

Question 27

cyproterone AEs

Answer 27

severe liver dysfunction (high dose), depression (first 6-8wks), rare meningiomas

Question 28

which of the following is false about progesterone GAHT
1. supplementation in feminizing tx is controversial due to side effect of lipid changes
2. may suppress LH and T
3. effects on breast, nipple, and areolae development are likely due to edema
4. AEs include depression and weight gain

Answer 28

1- no clear impacts demonstrateed in clinical trials

Question 29

what is an orhciectomy

Answer 29

removal of testes

Question 30

what is a permanent way to prevent sperm production and puberty + avoid being on blockers

Answer 30

orchiectomy

Question 31

what are some irreversible changes with masculinizing GAHT

Answer 31

clitoral growth, deepened voice, atrophy of breast tissue (lose glandularity, but generally does not lose mass or circumference)

Question 32

with masculinizing GAHT, there is atrophy of breast tissue with loss of _____, but generally does not lose ________

Answer 32

loses granularity
generally does not lose mass or circumference

Question 33

what are some somewhat reversible changes with masculinizing GAHT

Answer 33

altered body fat- muscle mass ratio (more upper body muscle), cessation of menses, increased libido, coarse hair growth (androgen dependent areas)

Question 34

what T supplementation has superior efficacy and a lower price

Answer 34

IM testosterone cypionate or enanthate qwk

Question 35

regarding T supplementation for GAHT
1. IM testosterone cypionate may have cyclic variations in effects with 2-4wks dosing
2. oral testosterone undecanoate may have more peaks and troughs than parenteral
3. oral testosterone undecanoate may have less peaks and troughs than parenteral
4. IM testosterone cypionate may have cyclic variations in effects with q1wk dosing
5. 1+2
6. 3+4

Answer 35

5

Question 36

AEs of testosterone for GAHT

Answer 36

polycythemia, infertility, acne, androgenic alopecia, HPTN, sleep apnea, weight gain, with RF (CVD, hypertriglyceridemia, T2D)

Question 37

what is a metoidioplasty

Answer 37

testicular prosthesis

Question 38

what is a phalloplasty

Answer 38

testicular/ penile prosthesis