Transgender Health

Question 1

What is sexual orientation?

Answer 1

an individuals’ attraction to the same and/r opposite sex

preferred to sexual preference

Question 2

What is gender?

Answer 2

internal sense of being male/female/other

other meaning somewhere on the cotinuum between male and female

Question 3

What is transgender?

Answer 3

self identity and general sense of self that does nto conform to one’s physical gender

Question 4

What is transsexual?

Answer 4

a person who has undergone treatment to become recognizable as the opposite sex

Question 5

What is gender non-conforming?

Answer 5

not corresponding to usual male.female identify of that culture

Question 6

WHat is gender dysphoria

Answer 6

biologic gender does not align with psychological gender and the stress that it causes

Question 7

What is the treatment for gender dysphoria?

Answer 7

reduce the distress it causes

feminizing or masculinizing hormones, sex reassignment surgery, counseling. effective treatment is unique to each person.

Question 8

What is the probable prevalence of this/

Answer 8

0.3%

Question 9

What is the high incidence of anxiety andd epression in these goups probably due to?

Answer 9

the stress of being in a minority group

not inherent to being transgender

Question 10

What percentage of transgender youth have attempted suicide?

Answer 10

54%

Question 11

What percentage of gender dysphoria will still persist into adulthood for children?

Answer 11

12-27%

so most resolve

Question 12

But if the first occurrence is in adolescence, what percentage persists into adulthood?

Answer 12

100%

Question 13

In children, which gender is more often affected?

Answer 13

males (but this could be social tolerance)

Question 14

At what age can symptoms of this start showing? At what age will it typically resolve (if it will resolve)?

Answer 14

2

around puberty

Question 15

FOr those that start in adolescents, when does body aversion start?

Answer 15

increases as secondary sex characteristics develop

Question 16

What is pubertal suppression

Answer 16

it’s a treatment for children with gender dysphoria - it suspends the develpoment of secondary sex characteristics

it’s reversible - so it provides some time to explore exactly what’s going on

Question 17

what hormone is used for male to female?

Answer 17

GnRH analogues or progesterone to suppress pituitary hormones and testosterone production

Question 18

What hormone is used for female ot male?

Answer 18

GnRH analogues

Question 19

WHat are the complications of these treatments?

Answer 19

decreased bone mineral density
decreased attainment of height
insufficient development of penile tissue for vaginoplasty

Question 20

What is the effect on fertility?

Answer 20

hormone therapy suppresses ovulation and sperm production

in adults, there is an option for cryopreservation of the gamete in surrogate, but pubertal suppression would not allow sperm banking or ova harvesting

Question 21

What percentage of TG individuals will use illegally obtained hromones due to barriers to health care?

Answer 21

50%

Question 22

WHat are the barriers here?

Answer 22

lack of insurance
lack of providers willing to prescribe
lack of coverage of hormones and surgery and mental health care

Question 23

What must the individual carry a diagnosis of before hormone therapy starts?

Answer 23

gender dysphoria established by a qulified mental health provider

Question 24

How long are individuals encouraged to live openly as the other gender before starting?

Answer 24

1 year

Question 25

Once you start estrogen therapy, when is the onset of change?

Answer 25

3-6 months to onset, but expected maximum effect takes 6 months to 2 years

Question 26

What are the desired effects of estrogen here?

Answer 26

breast growth, body fat redistribution, softening of skin, slowed body hair growth, decreased testicular size

Question 27

What are the adverse effects of estrogen?

Answer 27

decreased libido, decreased erectile function (can be a desired effect depending on sex life), decreased muscle mass

Question 28

What is the contraindication against estrogen?

Answer 28

previous DVT, estrogen, dependent neoplasm or end-stage liver disease

Question 29

What are some of the increased risks with estrogen

Answer 29

clotting, gall bladder disease, weight gain, hypertriglicerides, liver function abnormalities, cardiovascular disease, HTN, type 2 diabetes

Question 30

What are the expected effect of andoren hormone therapy?

Answer 30

deepend voice, clitoral enlargement, growth of facial and body hair, cessation of menses, atrophy of breast tissue, increased muscle mass

Question 31

WHat thnigs should you monitor in people on hormone therapy?

Answer 31

lFTs, prolactin, BP

Question 32

What is the antiandrogen drug in the US?

Answer 32

spironolactone

Question 33

What are the most effective at suppressing testosterone production though?

Answer 33

the GnRH analogues

Question 34

What is finasteride?

Answer 34

a 5 -alha reductase inhibitor to inhibit the formation ot metabolic testosterone production

Question 35

What are the risks for androgen therapy?

Answer 35

weight gain, acne, polycythemia, alopecia, hyperlipidemia, cardiovascular disease, hypertension

Question 36

What is the typical length of delay between hormone therapy and actual sex reassignment surgery?

Answer 36

29 years

Question 37

Does the ACA provide coverage for gender reassignment surgery?

Answer 37

yes, but the providers still aren't available so the out of network crap still applies

Question 38

What is intersex?

Answer 38

variation in sex determination at birth | need t check baby's genitalia thoroughly and never remove newborn's genitalia tissu3

Question 39

What should you do if you deliver a baby with questionalb genitalia?

Answer 39

image, do genetic testing, and explain everything to the parents do not remove any of the tissue and just wait until the individuals grows up

Question 40

True or false: men who have sex with men all identify as gay?

Answer 40

false - some gay men will ahve sex with women - either by crossing or covering

Question 41

true or false: youth lesbians have higher pregnancy rates

Answer 41

true don't get contraception and maybe have more sex with men to compensate

Question 42

true or false: trans-males don't need pap and clinical breast exams

Answer 42

false - still need them | standardized care!

Question 43

So what should you include in an exam of a trans-female?

Answer 43

1. yearly clinical breast exam 2. testicular and prostate health 3. birth control options/parenting desires

Question 44

What should you include in an exam of a trans-male?

Answer 44

1. pap 2. yearly breast exam 3. discuss birth control to stop period/prevent pregnancy 4. parenting desires