Transgender

Question 1

What is “sex”?

Answer 1

Pattern of biological sexual characteristics, based on physical characteristics

Question 2

What is “intersex”?

Answer 2

Anatomical or physiological aspects of the opposite sex, variations from the norm

Question 3

What is “gender”?

Answer 3

Culturally dictated expectations, actions, and behaviors which are dictated by the genitals

Question 4

True or false: gender is culturally specific, and variable over time

Answer 4

True

Question 5

What is gender identity?

Answer 5

Inner sense of place on the male-female spectrum

Question 6

When does gender identity set in?

Answer 6

2-3 years old

Question 7

What is asexual?

Answer 7

Not being attracted to other people

Question 8

What is the major issue with sexual identity in terms of sexual orientation?

Answer 8

Label

Question 9

What are sexual preferences?

Answer 9

Sexual desires of chosen activities, actions, and behaviors

Question 10

What is gender assignment?

Answer 10

The initial assignment at birth as male or female

Question 11

What is “gender atypical”?

Answer 11

Features or behavior that are not “typical” for the assigned gender in a given society in a given time

Question 12

What was gender identity disorder in the DSM IV?

Answer 12

Conflict between sexual identity and gender identity that causes distress

Question 13

What is gender dysphoria?

Answer 13

An individual’s affective/cognitive discontent/distress with the gender assignment

Question 14

What is the definition of transgender?

Answer 14

Broad spectrum of individuals who identify with a gender difference from their natal gender

Question 15

What is a transexual?

Answer 15

An individual who seeks, or who has undergone, a social transition from male to female or v.v

Question 16

What is the transition period?

Answer 16

The period during which an individual is moving from the assigned sex at birth to their gender identity

Question 17

Is hormonal therapy FDA approved for transsexual?

Answer 17

No

Question 18

What is gender reassignment?

Answer 18

Denotes an official, usually legal change of a gender

Question 19

What are bigendered people?

Answer 19

People who identify as both masculine and feminine

Question 20

Who are androgynes?

Answer 20

Midline between masculine and feminine

Question 21

Who are agender people?

Answer 21

People who do not identify as a male or female

Question 22

In terms of the diagnostic criteria for gender dysphoria, what is the duration that is needed? Of the 6 criteria, how many are needed?

Answer 22

-6 months

2/6

Question 23

What are the six criteria that are used to diagnose gender dysphoria?

Answer 23

1. Incongruence between one’s experienced/expressed gender
2. Desire to be rid of primary and/or secondary sexual characteristics
3. Strong desire for the primary/secondary characteristics of the other gender
4. Strong desire to be of the other gender
5. Desire to be treated as the other gender
6. Conviction that one has the typical feelings and reactions of the other gender

Question 24

True or false: the suicide risk associated with transgender pts can persist after reassignment

Answer 24

True

Question 25

Often, cross gender behavior present before what age?

Answer 25

3

Question 26

Who generally more often experiences gender dysphoria?

Answer 26

Males

Question 27

What is the typical outcome of boys who express cross-gender behavior?

Answer 27

Homosexual men

Question 28

True or false: in terms of trans people, if they've got it, it needs to be checked

Answer 28

True

Question 29

What is cis-genderism?

Answer 29

The idea that everyone is comfortable with their assigned sex

Question 30

What percent of trans people smoke?

Answer 30

45-75%

Question 31

What are the mental health disorders with trans people?

Answer 31

- Depression - Anxiety - PTSD

Question 32

True or false: trans people are more at risk of substance abuse

Answer 32

True

Question 33

True or false: transgender people of color have a high risk of contracting HIV

Answer 33

True--63%

Question 34

What are the immunizations that should be given to trans people? (3)

Answer 34

- Hep A - Hep B - HPV

Question 35

What should be asked of transgender pts when seeing them for the first time?

Answer 35

-Ask name and pronoun use

Question 36

Is it appropriate to ask if a person has had their surgery yet?

Answer 36

No, implies that they are not themselves until they undergo their surgery

Question 37

What is the hormone care for transmen?

Answer 37

Testosterone

Question 38

What is the hormone treatment for transwomen?

Answer 38

Estrogens | Antiandrogens

Question 39

What is the dose for testosterone?

Answer 39

200 mcg/cc IM

Question 40

Should you use oral or topical forms of testosterone?

Answer 40

Topical, sure. Oral, no.

Question 41

What happens to the clitorus with testosterone?

Answer 41

Enlarges

Question 42

What are the fertility issues with trans people?

Answer 42

Should store eggs / sperm if possible before hormonal therapy

Question 43

What are "top" surgeries?

Answer 43

Mastectomy and male chest construction

Question 44

What are "bottom" surgeries?

Answer 44

- Metoidioplasty | - Penile reconstruction/ phalloplasty

Question 45

What are the three hormones needed for MTF pts?

Answer 45

Estrogens Antiandrogens Progesterone

Question 46

What type of estrogen is used for hormonal therapy for MTF pts? Why?

Answer 46

Estradiol SL route and it is pure physiologic estrogen

Question 47

What are the advantages of using estradiol SL?

Answer 47

Avoids first pass by the liver

Question 48

What is the major risk of using injected estrogen?

Answer 48

Longer duration of action = increased side effect risks

Question 49

What are the contraindications for estrogen therapy use? (4)

Answer 49

- Estrogen dependent CAs - h/o PE - Thrombophlebitis - pituitary adenoma

Question 50

When should estrogen be stopped temporarily?

Answer 50

Surgery or trauma

Question 51

What is the antiandrogen that is commonly used for MTF? Why?

Answer 51

Spironolactone | blocks both testosterone production and action at receptors

Question 52

What is the role of progesterone for MTF pts? (3)

Answer 52

- not routinely used - May assist in body fat redistribution - Suppress testosterone

Question 53

What is the role of speech coaches for trans people?

Answer 53

Need to adjust to sex

Question 54

What is the common antiandrogen used for transsexual therapy?

Answer 54

Spironolactone

Question 55

What is the MOA of spironolactone?

Answer 55

Aldosterone inhibitor (K sparing diuretic)

Question 56

What are the drugs that can cause gynecomastia? (5)

Answer 56

"some drugs create awesome knockers" - Spironolactone - Digitalis - Cimetidine - Alcohol - Ketoconazole