Gender Flashcards
(23 cards)
UCLA study estimated ____ of teen 13-17 are transgender
and about ____ of US adults (1.4 million)
- 7
- 6
New study looking at 80,000 9th and 11th grade students in
Minnesota
>2,000, ~ ___ TGNB (transgender and nonbinary)
2.7%
Infants as young as ____ months of age distinguish
between categories of faces
3-4 months
_____ months can discriminate between high-and low-
pitched voices
6-8 months
By _____ months toddlers engage in verbal gender
labeling and show gender type toy awareness
24-31
By _____ years of age, gender influences preferences
related to play, peer groups, and clothing
3-5
gender dysphoria
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
In children, gender dysphoria diagnosis involves at least ____ of the following and
an associated significant distress or impairment in function, lasting at least _____
months:
6 and 6
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:
6 and 2
phases of transitioning
reversalbe
partially reversable
irreversable
reversable transitions
- Toys
- Activities
- Clothing/hair
- Jewelry/Make-up
- Speech
- Packing
- Binding*
- Tucking*
- GnRH analogues
partially reversable
Hormone affirming
therapy
- testosterone
- estrogen
irreversable
Gender-
affirmation surgery
- “Top surgery”
- “Bottom
surgery”
GnRH analogue
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
GnRh agonist therapy
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
thelarchy
breast budding - first sign of puberty in people with ovaries
optimal intervention point
GnRh Agonist therapy application
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
challenges of GnRH Agonist Therapy
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
gender affirming hormones - when?
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
Vaginoplasy
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
phalloplasty
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
Metoidioplasty
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
