EM Special 11: Transgender Patient

Question 1

electrolyte imbalance associated with gender-affirming hormone therapy

Answer 1

Hyperkalemia (with spironolactone use)

Question 2

Puberty blockers can be initiated once a child reaches the pubertal stage of Tanner stage ____

Gonadotropin blockers

Answer 2

II

Question 3

Because the puberty blockers work to occupy the receptors in the pituitary, initially there is an increase in gonadotropin production followed by suppression. This increase is termed the flare and happens when?

Answer 3

roughly 10 days after initiation

Question 4

the goal with masculinizing hormones is:

Answer 4

to suppress estradiol levels and achieve male range total testoterone levels (320 to 1000 ng/dL)

Testosterone at this level suppresses menses, increases libido, increases clitoral size, etc

Question 5

TRUE or FALSE
Transmasculine persons who have been prescribed testosterone continue to have risks for estrogen-sensitive pathology

Answer 5

TRUE

Question 6

TRUE or FALSE
Testosterone does not provide any form of birth control

Answer 6

TRUE
Screen for pregnancy if the patient has a uterus and ovaries, regardless of testosterone use.

If a patient is found to be pregnant, stop testosterone pending pregnancy planning

Question 7

1st priority in accommotading a transgender patient

Answer 7

Ensure the patient is addressed in the desired manner consistently

Question 8

State of distress in the context of transgender care

Answer 8

Gender dysphoria

Question 9

Complications of Feminizing Hormone Therapy (4)

Answer 9

1. Hypercoagulability (VTE)
2. Electrolyte imbalances (Hyperkalemia)
3. Prolactinoma
4. increased risk of cardiovascular disease

Question 10

Complications of Masculinizing Hormone Therapy

Answer 10

Erythrocytosis

Question 11

Goals in using Masculinizing Hormones (2)

Answer 11

1. Suppressing estradiol levels
2. Total Testosterone to 320-1000ng/dL

SE: Increased Hematocrit (>50%) = increased risk of CVD, thrombosis, vaginal dryness, dec HDL, elevated transaminase

Question 12

Breast Tissue Cancer Risk

Answer 12

Transfeminine patients: proliferative tissue

Transmasculine patients: residual tissue

Question 13

Two forms of Feminizing Hormones

Answer 13

1. 17B Estradiol
2. Anti-androgens (spironolactone, Finasteride, Gonadotropin-releasing hormone)

goal of estradiol: <55ng/dl

Question 14

MOA of anti-androgens

Answer 14

1. Spironolactone - inhibits testosterone secretion and androgen binding to receptors
2. Finasteride - inhibits conversion of testosterone to dihydrotestosterone
3. GRH - Suppress gonadal steroid production

Question 15

Complete expulsion of vaginal skin graft that usually occurs in the 1st post op week indicates?

Answer 15

Failure of procedure

Question 16

What can develop in penile inverted tissue?

Answer 16

Melanoma
Psoriasis

Question 17

In Genital Masculinizing procedures, dysuria with a negative urine culture indicates?

Answer 17

Stricture

Question 18

Genital Masculinizing Procedure complications

Answer 18

1. Strictures: dysuria, reduced stream, inability to pass catheter
2. Vaginectomy = rectal injury
3. Fistula = skin or neophalus, scrotum, perineal suture sites
4. Erosion through skin of erectile implants