transgender healthcare

Question 1

what is binary gender?

Answer 1

only two distinct genders exist- man and
woman

Question 2

what is cisgender?

Answer 2

a person whose gender corresponds to the sex
that they were assigned at birth

Question 3

what is gender?

Answer 3

a range of attributes linked to male and female, not linked to an individual’s biological sex

Question 4

what is gender expression?

Answer 4

how an individual performs their sense
of self, through their actions, interests, and appearance

Question 5

what is gender dysphoria?

Answer 5

an individual’s unhappiness at the
disparity between the gender which they were assigned at birth and their gender identity

Question 6

what is gender identity?

Answer 6

an individual’s feeling of what gender
they most associate with

Question 7

what is heteronormativity?

Answer 7

: the idea that heterosexuality is
the norm for sexual orientation and gender binaries of male and female are the only ones that exist

Question 8

what is medicalisation?

Answer 8

the process by which non-medical
problems and conditions become known by and treated as medical ones

Question 9

what is pharmacotherapy?

Answer 9

the treatment of a disorder,
disease, or condition with medication

Question 10

what is queering?

Answer 10

a method of questioning and challenging
processes and systems in society that focus on, or are based upon, heterosexuality or gender binaries

Question 11

what is sexuality?

Answer 11

the way in which an individual expresses
themselves sexually through different feelings and behaviours

Question 12

what is transgender?

Answer 12

desire to move away from a gender that
has been assigned to that person at birth

Question 13

what is transphobia?

Answer 13

a collection of ideas that incorporate a
range of negative attitudes, feelings, or actions towards transgender people

Question 14

how is equality and diversity regulated in healthcare?

Answer 14

• All healthcare services have a duty to treat their patients with respect and adhere to relevant legislation, such as the Equality Act, 2010, and Gender Recognition Act, 2004

Question 15

how did the medical professional medicalised transgender patients?

Answer 15

• Transgender patients forced to conform to pre-existing medical beliefs to access care (Hird, 2022)
• Labelling these patients as ‘ill’ or ‘needing cured’
  perpetuates the idea that they need ‘healed’ or ‘cured’
• This medical and psychiatric scrutiny allows the pursuit for a ‘cause’ of transgenderism to continue

Question 16

what did medicalisation of trans patients lead to?

Answer 16

n led to inclusion in Diagnostic and
Statistical Manual of Mental Health Disorders (DSM) of the American Psychiatric Association (APA)

Question 17

what are general health concerns?

Answer 17

• Co-morbidities:
  – Consider if existing conditions may be exacerbated by treatment with or deficiency of oestrogen and testosterone
• Obesity- why is this a concern?
  – Increased risk of adverse effects and complications related to hormone treatment.

Question 18

what are the effects of gender dysphoria?

Answer 18

This sense of unease or dissatisfaction may be so intense it can lead to depression and anxiety and have a harmful impact on daily life

Question 19

when can HCP refer for gender dysphoria? how do they help?

Answer 19

(>17 years) to the Gender Dysphoria service (Currently developing a self referral route)
* Clinics offer services such as: psychological support and counselling, speech and language therapy and cross-sex hormone therapy
* May apply to legally change their gender

Question 20

what sugery options are there for trans people from female to male?

Answer 20

• In patients transitioning female to male (FTM) may involve: removal of both breasts (bilateral
  mastectomy), nipple repositioning, dermal implant, construction of a penis (phalloplasty) construction of a scrotum (scrotoplasty) and testicular implants and a penile implant.
• In addition, removal of the womb (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy) may also be considered

Question 21

what surgery options are there for mens transitioning to women?

Answer 21

• In patients transitioning male to female (MTF) may involve: removal of the testes (orchidectomy), removal of the penis (penectomy), construction of a
  vagina (vaginoplasty), construction of a vulva
  (vulvoplasty) and construction of a clitoris
  (clitoroplasty)
• Breast implants and facial feminisation surgery are not routinely available on the NHS

Question 22

what is the aim of hormone treatment?

Answer 22

– Reduce gender dysphoria
– Alter secondary sex characteristics
– It can provide significant comfort to people who experience gender dysphoria

Question 23

when is hormone treatment indicated?

Answer 23

– Persistent, well-documented gender dysphoria
– Capacity to make a fully informed decision and to consent for treatment
– If significant medical or mental concerns are present, they must be reasonably well-controlled

Question 24

when is estradiol recommended?

Answer 24

• Alleviation of gender dysphoria in MTF patients
• Only estradiol and its esters are recommended for treatment of gender dysphoria.

Question 25

what are the contraindications/ cautions for estradiol?

Answer 25

* Contradindications – Hx oestrogen dependent tumours. Recent thrombotic disease (new / unstable angina or recent myocardial infarction / stroke / TIA) * Cautions: * Obesity, smoking, breast cancer, hx thromboembolic disease, CAD, high CV risk, poorly controlled diabetes, severe migraine, hypertriglyceridemia, severe liver disease

Question 26

who would testosterone be indicated in?

Answer 26

* Testosterone for alleviation of gender dysphoria in FTM patients * Goal to achieve trough serum testosterone levels in the lower third of the male reference ranges

Question 27

who would transdermal testosterone preparations be recommended for?

Answer 27

– Consider in older patients, obesity and smokers. May confer lower risk of polycythaemia, thrombosis and liver dysfunction. – Allow smaller doses and increments

Question 28

who would testosterone be contraidicated in/ cautioned?

Answer 28

* Contradindications – Hx oestrogen dependent tumours. Recent thrombotic disease (new / unstableangina or recent myocardial infarction / stroke / TIA) – Sustanon® contains arachis (peanut) oil and should not be prescribed for patients known to be allergic to peanut * Cautions: * Obesity, smoking, breast cancer, hx thromboembolic disease, CAD, high CV risk, poorly controlled diabetes, severe migraine, hypertriglyceridemia, severe liver disease

Question 29

who are GnRH analogues indicated in?

Answer 29

* Alleviation of gender dysphoria in FTM patients AND MTF patients AND as ‘puberty blocker’ Used to achieve maximum suppression of endogenous sex hormones

Question 30

what is the role of GnRH analogues in male assigned?

Answer 30

* Inhibit the secretion of pituitary gonadotrophins leading to low circulating levels of testosterone * Treatment goal is to achieve equivalent female levels of testosterone

Question 31

what is the role of GnRH analogues in female assigned?

Answer 31

* Suppression of endogenous sex steroid production and, thereby, attenuation of secondary female sexual characteristics such as menstruation * Maximises masculinisation achieved by testosterone * They inhibit the secretion of pituitary gonadotrophins leading to low circulating levels of ovarian hormones

Question 32

what is the role of GnRH analogues in children and young people?

Answer 32

* Suppress puberty by delaying the development of 2’ sexual characteristics. Alleviate distress associated with the development of 2’ sex characteristics, providing time for on-going discussion and exploration of gender identity before deciding whether to take less reversible steps

Question 33

who are GnRH analogues contraindicated in/ cautioned in?

Answer 33

* Contraindications: – Pregnancy, breastfeeding * Caution: – Metabolic bone disease, uncontrolled diabetes

Question 34

who are antiandrogens indicated in?

Answer 34

* Alleviation of gender dysphoria in male assigned adults * Not as commonly used in the UK