Caring for Transgender Pts Flashcards
(83 cards)
1
Q
____ is one’s sense of being male or female
A
gender identity
2
Q
___ is how one thinks of oneself in terms of whom one is romantically or sexually attracted to
A
Sexual identity
3
Q
___ is an individual’s expression of gender
A
Gender presentation
4
Q
___ is a term that can apply to a wide variety of cross-gender behaviors and identities
A
Transgender
5
Q
T/F: Transgender is not a medical or psychiatric term
A
T
6
Q
Is the word transgender an adjective or noun?
A
adjective (transgender person)
7
Q
What the the term for transitioning from Male to Female (MTF)
A
transfemale
8
Q
What the the term for transitioning from Female to Male (FTM)
A
transmale
9
Q
Transsexual is a ____ term.
This is a patient who is seeking ___ and/or _____, which may include a legal change in gender status
A
medical (adjective, not a noun)
hormonal
surgical body modification
10
Q
Transvestite is a ____ term
A
Psychiatric
**Males who wear female clothing for sexual gratification and may experience significant distress
11
Q
What is required for dx of transvestite?
A
For women or men
- must cause significant distress
- clothing worn for sexual gratification
12
Q
What is the “golden rule” for caring for transgender pts?
A
Tx the person in front of you
- Respect their gender identity
- Provide screening/prevention for the anatomy that’s present regardless of presenting gender or self-identification
13
Q
___ % of transgender pts have attempted suicide
A
41%
14
Q
__% of transgender pts have experienced family rejection
A
57%
15
Q
___ % of transgender pts have lost a job because of their identity
A
55%
16
Q
___% of transgender pts have been harassed/bullied in school
___ % experience physical assault
___% experience sexual assault
A
harassed/bullied: 51%
physical assault: 61%
sexual assault: 64%
17
Q
___ % of the transgender population have been homeless at some point in their lives
A
19%
18
Q
There are higher rates of ___, ___, and ___ use (behaviors) in transgender pts
A
HIV (4x)
smoking
Alcohol use
19
Q
__% of transgender pts postpone medical care due to discrimination
A
28%
20
Q
T/F: Not every transgender pt will want hormone tx
A
T
21
Q
What kind of hormones will you give the following pts interested in transitioning?
Male: ______
Females: ____
A
Estrogens (progesterones)
Androgens
22
Q
Is hormone tx for sexual transitioning considered on or off-labeled?
A
Off-labeled
**code for tx of gender dysphoria
23
Q
What pt education do you need to provide for transgender pts?
A
expectations risks long term considerations medications fertility (may want to consider banking)
24
Q
T/F: Minors can qualify for emancipation for hormone therapy to help them transition
A
F: This does not exist
25
Is oral or non-oral estrogen preferred?
non-oral (avoid 1st pass)
26
What are the estrogen therapy options for male to female ?
sublingual, transdermal, injectable
27
What population do you need to be cautious about tx w/ estrogen while transitioning?
smokers >35 y/o
28
After orchiectomy, (lower/higher) doses of hormones are needed
lower
29
What do you need to monitor during hormone therapy in male to female transition?
liver fxn
30
What are the effects of progesterone in male to female transitions?
```
+ effects on nipple areola and libido
+/- mood effects (depression)
wt gain
CVD risk
bone loss
```
31
What are the names of the anti-androgen drugs that can be used in male to female transition? (x2)
What must be monitored while taking each?
spironolactone --> potassium
| finasteride (5a-DHT antagonist) --> adjunct for hair loss
32
What changes in odor may a pt notice when transitioning from male to female?
sweat/urine odor changes
33
What skin changes occur in male to female transitioning?
skin: dry, thin, easier bruising, small pores w/ less oils
34
What breast changes occur in male to female transitioning?
breast buds develop
35
What happens to weight distribution in male to female transition?
wt distribution changes, to hips and thighs
| wt gain or wt loss can occur
36
What muscular changes occur during male to female transition?
decreased muscle mass (strength decreases)
37
What hair changes occur during male to female transition?
body hair decreases in thickness and distribution
grows slower
**will not completely go away
38
What can a pt do to remove hair during male to female transition?
electrolysis, shaving, laser, waxing, plucking, etc
39
What anatomical things do NOT change in male to female transition?
bones
| ** ligaments can change (new shoe size)
40
What changes occur in the male genitalia while that are transitioning to female?
decrease in erections
testicular atrophy
permanent sterility
41
T/F: Emotional changes can be significant when a male is receiving hormonal therapy
T
| - psychotherapy may or may not change
42
What skin changes occur in female to male transition?
Skin thicker, more oily, larger pores, acne, increased sweating (odor changes)
43
What breast changes occur in female-male transition?
Breasts decrease (wait 6 mo before surgery)
44
What happens to wt distribution in female-male transition?
More fat around abdomen and thighs
45
What musculature changes occurs in female-male transition?
Increased muscle mass and strength
46
What hair changes occurs in female-male transition?
Hair increases in thickness, darkens and grows faster
pattern will mimic other men in family (male pattern baldness can occur)
** takes 5 years to get final results
47
What are the testosterone forms for female-male transition?
What do you need to monitor?
IM, patch, gel
**dose titrated to effect
liver, blood counts
48
What can occur if there is too much testosterone is given to a pt in female-male transition?
Too much can convert to estrogen = undesired feminization
49
T/F: Trans-men cannot get pregnant
F, they can (use contraception!)
| **fertility if impaired, but not absent
50
What can you use to tx male pattern baldness?
Finasteride
| Topical minoxidil
51
How can you tx low libido in female-male transition?
Low dose SSRI
52
What gynecological changes can occur in female-male transition?
Clitoral enlargement
| Lighter, shorter periods (eventually stop)
53
PCO-like picture is common because androgen exposure leads to ____
Pts may need evaluation for uterine _____
Anovulation
| Hyperplasia
54
Are pt transitioning from female-male still at risk for ovarian/cervical CA
Yes
| ** pap smear, pelvic exam is still required
55
Many recommend hysterectomy w/in ___-___ years of hormone initiation because of tendency to recruit follicles but not ovulate them
5-10 yrs
| consider when fertility is not an issue, pt is >40 yrs, surgical risk is low
56
Why is there an increase in risk of heart dz and HLD in female-male transitioning?
Androgen effect
57
Frequency of visits depends on where in the transition your pt is: initially every __ weeks, tapering as pt progresses/stabilizes
4 weeks
58
What should be checked at routine medical visits for pts transitioning, no matter who they are?
```
Monitor BP
Hormone side effects
Emotional changes
Weight
QOL
```
59
What should be checked at routine medical visits for transmen?
Osteoporosis (consider Vitamin D and calcium)
Assess menses
- Add progesterone if a period continues beyond 3 mos, and consider endometrial bx
60
What should be checked at routine medical visits for transwomen?
Check potassium if on spironolactone
61
What annual exams need to be performed for transwomen?
Mammogram starting 40-50 y/o
| Rectal exam w/ PSA from 50 y/o (NEED DRE)
62
T/F: Pap smears in postoperative for transwomen pts are unnecessary
T: vaginoplasty does not create a cervix at risk for HPV
63
What "maintenance" steps must be taken in transwomen after vaginoplasty?
Pt must dilate vagina x3-4 daily w/ dilators (sexual activity counts)
64
What annual exams need to be performed for transmen? (a lot)
T levels q 6 mo (midcycle bt injxns)
- check troughs is mood or energy levels are low
Hemoglobin (use male level to compare)
Annual lipid assessments for pts > 30
Annual mammogram starting age 40 – 50
Bimanual pelvic exam (q1-2years)
Pap (q 2-3 yrs)--> warm pathologic
pelvic U/S (for new vaginal bleeding w/ uterus)
TSH (@ age 45, q3 yrs)
Bone density screen 5-10 years after starting T
65
What baseline labs do you need for transwomen? (x4)
```
Fasting lipids (if on an oral estrogen regimen)
Potassium and creatinine (if on spironolactone)
Liver function
```
66
What baseline labs do you need for transmen
hemoglobin
lipids
Testosterone (use male levels to evaluate)
67
What can causes vaginal bleeding in transmen that is not CA?
Missed testosterone doses
Excessive testosterone dosing leading to increased Estrogen levels
Weight changes
Thyroid d/o
68
How should you screen transwomen currently taking estrogen for CAD/CVD?
Closely monitor for cardiac events or sxs
- especially first 1-2 yrs of hormone therapy
* *Use transdermal estrogen in pts at high risk (including pre-existing CAD)
HTN: monitor BP every 1-3 months
- is BP needs lowered, use sprionolocatone
69
When do you need to screen transmen for CVD?
Not on T --> tx hyperlidipidemia normally
Planning to start hormones w/in 1-3 yrs
- get SBP<130, DBP <90, LDL <135
Currently taking T
- same as transwomen
- lipids: daily topical, biweekly IM best for hyperlipidemia LDL<135
70
How should you screen a transwoman taking estrogen for DM?
Annual test
- GTT or A1C if impaired glucose
- use normal guidelines to tx
- decrease estrogen if glucose is difficult to control
71
How should you screen a transman taking testosterone for DM?
Screen and tx as non-transgender pts
| - may screen for PCOS
72
Why is DM a "touchy" subject for a transman?
- may intentionally gain weight to obscure breast/hip appearance
- they may not realize the increased metabolic demands when taking T
73
Transwomen are at risk for developing ____ in order to maintain a slight build.
eating d/o
74
How should you supplement all trans pts who take cross-sex hormones and/or have had or anticipate gonadectomy
Supplemental calcium and vitamin D
75
Transmen taking T are at risk for _____ rupture, especially in transmen involved in strength training.
How can you educate them to avoid this complication?
tendon
increase weight load gradually
Emphasize stretching
76
What sexual Hx question are important for transgender pts?
```
# of partners
sexual orientation changes (this can change as hormonal changes occur)
contraception
self destructive behaviors
```
77
When is HIV and Hep B/C screening recommended for transgender pts?
high risk: every 6-12 months
| low risk: 1x during lifetime
78
How often should a transgender pt w/ high risk behaviors be screened?
Every 6 mo (G/Cl, syphilis)
79
What type of tissue is present in neovaginas in transwomen?
```
Skin (not mucosa)
If mucosa (usually urethral or colon)
```
80
Mammogram should be preformed on Transwomen on hormones for ___+ years and at least ____ y/o, unless strong FHx of breast or ovarian CA --> Screen earlier
30+ yrs 50 y/o
81
When should Transmen have bone density screening?
> 60 yo and testosterone < 5-10 yrs
82
T/F: There is no upper age limit for beginning hormones?
T
83
Who usually sees slower results: transmen or transwomen?
transmen
