Gender

Question 1

UCLA study estimated ____ of teen 13-17 are transgender
and about ____ of US adults (1.4 million)

Answer 1

0. 7
1. 6

Question 2

New study looking at 80,000 9th and 11th grade students in
Minnesota
 >2,000, ~ ___ TGNB (transgender and nonbinary)

Answer 2

2.7%

Question 3

Infants as young as ____ months of age distinguish
between categories of faces

Answer 3

3-4 months

Question 4

_____ months can discriminate between high-and low-
pitched voices

Answer 4

6-8 months

Question 5

By _____ months toddlers engage in verbal gender
labeling and show gender type toy awareness

Answer 5

24-31

Question 6

By _____ years of age, gender influences preferences
related to play, peer groups, and clothing

Answer 6

3-5

Question 7

gender dysphoria

Answer 7

Medical diagnosis
 Discomfort or distress that is caused by a discrepancy
between a person’s gender identity and their sex
assigned at birth, including their physical sex
characteristics and the associated gender role
 Separate from being TGD

Question 8

In children, gender dysphoria diagnosis involves at least ____ of the following and
an associated significant distress or impairment in function, lasting at least _____
months:

Answer 8

6 and 6

Question 9

In adolescents and adults, gender dysphoria diagnosis involves a difference
between one’s experienced/expressed gender and assigned gender, and
significant distress or problems functioning. It lasts at least ____ months and is
shown by at least ______ of the following:

Answer 9

6 and 2

Question 10

phases of transitioning

Answer 10

reversalbe

partially reversable

irreversable

Question 11

reversable transitions

Answer 11

• Toys
• Activities
• Clothing/hair
• Jewelry/Make-up
• Speech
• Packing
• Binding*
• Tucking*
• GnRH analogues

Question 12

partially reversable

Answer 12

Hormone affirming
therapy
- testosterone
- estrogen

Question 13

irreversable

Answer 13

Gender-
affirmation surgery

• “Top surgery”
• “Bottom
  surgery”

Question 14

GnRH analogue

Answer 14

if give constant stream of GnRH it will turn it off - GnRH analogue is a synthetic constant stream that stops producing estrogen and progesterone.

when remoed analogue - the system turned back on - pause button for puberty

Question 15

GnRh agonist therapy

Answer 15

 Fully reversible “puberty blockers” / “puberty suppression”
 Inhibition of the hypothalamic-pituitary-gonadal axis
Rationale:
 Additional time for gender exploration can be created without
pressure of ongoing pubertal development
 Enables the patient to experience only the physical
changes of puberty that match the affirmed gender
identity

Question 16

thelarchy

Answer 16

breast budding - first sign of puberty in people with ovaries

Question 17

optimal intervention point

Answer 17

Question 18

GnRh Agonist therapy application

Answer 18

 Start at SMR 2 pubertal staging
 Leuprolide acetate IM injection
1 or 3 month preparations at dose sufficient to
suppress pituitary gonadotropins and gonadal
sex steroids

 Histrelin acetate subcutaneous implant
Once yearly dosing

Question 19

challenges of GnRH Agonist Therapy

Answer 19

Some people consider this controversial
 Long-term outcomes data sparse
 Possible temporary adverse effect on bone density
 Can impact peak height velocity
 Expensive/not always covered by insurance
Leuprolide 3 month ~$980
Histrelin 12 month ~$12-15,000

Question 20

gender affirming hormones - when?

Answer 20

Gender affirming hormones can be initiated at
about the age of 16 years
Legal age for medical decision-making in
some countries
 Some centers studying earlier administration (14
years)
Approximates the upper end of the age
range for normal pubertal onset

Question 21

Vaginoplasy

Answer 21

Most common approach is penile inversion, where a vaginal vault is created between the rectum and the urethra
 Vaginal lining is created from penile skin
 An orchiectomy is performed and the labia majora are created using scrotal skin
 The clitoris is created from a portion of the glans penis
 The prostate is left in place to avoid incontinence

Question 22

phalloplasty

Answer 22

Involves the creation of a penis using skin from the forearm or thigh
 Donor skin is rolled into a tube like structure
 An erectile implant may be placed
 Scrotoplasty (+/- testicular implants) may also be performed using skin flaps
 A urethral hookup may be performed using cheek or vaginal mucosa

Often the entire phalloplasty procedure involves multiple staged surgeries
 Most commonly after a hysterectomy and vaginectomy

Question 23

Metoidioplasty

Answer 23

 Greek word that means “towards male genitalia”
 Testosterone causes growth of the clitoris (1-3 inches)
 The enlarged clitoris is separated from the labia minora
 Patients may opt to have a urethra placed in the phallus
 A scrotum can be created from the labia majora and a
vaginectomy may be performed
 Testicular implants are typically placed at a second stage