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Primary care II > Transgender pt > Flashcards

Transgender pt Flashcards

1
Q

transgender

A

individuals who do not conform to the gender norms of their natal sex (assigned gender).

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2
Q

cisgender

A

individuals whose gender identity is consistent with their natal sex (assigned gender).

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3
Q

natal sex

A

the sex of an individual at the time of birth.

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4
Q

gender identity

A

the gender an individual identifies as regardless of their natal sex (assigned gender).

male female both or neither

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5
Q

transexual

A

diagnostic term- person who wants to live as opposite of their birth assigned sex and seeks medical treatment to make their body congruent with their identity through hormones and/or surgery.

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6
Q

gender expression

A

How a person expresses their gender through the way they behave, hair style, the way they dress, etc.

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7
Q

gender variant/non-conforming def

A

When a person’s gender expression is different from societal norms

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8
Q

sexual orientation

A

How a person identifies their physical and emotional attraction to others

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9
Q

Gender identity does not equal ___________

A

sexual orientation

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10
Q

intersex

A

Person born with sexual or reproductive anatomy that is not typical for either male or female

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11
Q

pansexual

A

Person who is attracted to any genders, not limited to the male-female binary

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12
Q

Terms not used

Transvestite-
Tranny-
Hermaphodite-

A

transvestite- cross dress
tranny- derogatory transgender
hermaphordite- intersex

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13
Q

Gender dysphoria in children DSM V criteria

A

strong incongruence between one’s experienced/expressed gender and their assigned gender and this must be at least 6 months in length**
6 of following:
desire to be other gender, cross dress, role play other gender, toys/games other gender, playmates of opposite sex, rejection of toys from assigned gender, dislike of anatomy, sex characteristics

impairs functioning

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14
Q

Gender dysphoria adults and adolescents criteria dx

A

incongruence x 6 months

+2 of these: incongruence, desire to rid sex organs, get other gender sex characteristics, be other gender, to be treated as other gender, reactions/feelings of other gender

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15
Q

Posttransition definition

A

full time living in new gender plus one sex reassignment surgery

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16
Q

gender affirmation def.

A

process of gender change

  • coming out
  • changing pronoun, -hormones
  • legal changes
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17
Q

WPATH standards of care

A 
assessment of children 
mental health
hormones 
voice/communication therapy
surgery
life long prevention primary care
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18
Q

children with dysphoria vs adolescent…will they transition later in life?

A

children- many do not go on to be trans

adolescent- majority will

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19
Q

standard of care for children with dysphoria

no changes until ______
length of time before initiation_______

A
  • no changes until evaluated by mental health

- no set length of time to be in therapy before initiation

20
Q

hormone to prevent puberty

used until age____

fertility?

A

gonadotropin-releasing hormone (leuprolide acetate IM monthly)

used until legal age to decide if want gender affirming hormones or surgery

does not effect fertility

21
Q

Labs/dx for suppression of puberty

q 3 months
q year

A

q 3 mos: height* weight tanner + LH FSH estradiol/testosterone

q year: renal, lipids, liver, glucose, hemoglobin
bone density, bone age

22
Q

when to begin suppression of puberty

A

tanner stage 2

23
Q

criteria for hormone therapy for gender affirmation

-documented_____
-can make_____
-
-control of?

A
  • persistent, documented dysphoria
  • can make informed decision
  • age of majority
  • if medical or psych issues must be controlled
24
Q

Hormone targets for:
transgender male

transgender female

A

(FTM)- testosterone target (300-1,000)

MTF- decrease testosterone promote levels of estradiol (>200) with anti-androgen and estrogen

25
Q

Risk of feminizing hormones

likely
likely with factors
possible
no risk

A

likely: thrombo, gallstrones, elevated LFT, weight gain, high triglycerides

likely with factors: cardiovascular

possible risk- diabetes type II

no risk- breast cancer

26
Q

Risk of masculinizing hormones

likely
possible risk
no risk

A

likely- polycythemia, weight gain, acne, androgenic alopecia, sleep apnea

possible- destabilization (cardio, HTN, type II diabetes)

no risk: bone density, reproductive cancers

27
Q

Baseline labs before initiating hormones (not hormones)

Trans men:

Transwomen:

A

Transmen: hgb, lipids

Transwomen: lipids, electrolyte, renal, ?liver

28
Q

FtM hormones available in what forms and how often given?

A

Depo-testosterone, delatestryl q week x 1 month adjust to suppress period and create male characteristics

androgel, androderm (patch) start 2.5

29
Q

FTM monitoring

follow up at what intervals?

labs - target level, other

screening

A

1 month, 3, 6, then q 6-12

testosterone (300-1000) peak level 1-2d after injection, trough-before

Hct, lipid

BMD (screening for those at risk or 10 years after starting hormone)

Chest/axillae- increased risk breast CA (compared to natal males)

30
Q

Characteristics that are not reversible in FTM after hormones

A

clitoral enlargement, voice, scalp loss

31
Q

hormones MTF

Two types and examples for each

1)  -
    -
2) -
    -
    -
A

Estrogen
1) dermal 2x/wk if >40 y or
risk for DVT
2) oral estrace if <40 and low risk DVT

Androgen antagonist

  1) Aldactone
  2) Proscar
  3) Androcur
32
Q

aldactone considerations

A

if on ACEI- max 25 mg and monitor K+

if renal insufficiency- start at 50 increase by 50 q week- renal function testing with each increased dose

33
Q

monitor mtf

follow up intervals

labs- hormones, other

screening
PSA?

A

1 mo, 3, 6, then q6-12

testosterone (30-100)
E2 <200
prolactin q 1-2 y
potassium
screen breast and prostate cancer (no PSA, estradiol makes it low)
34
Q

Breast cancer risk

Transwomen (no hormones)
Transwomen (hormones)
Transmen (no surgery)
Transmen (surgery)

A

TW no hormone- no increased risk

TW on hormones- lower risk than females, but higher than other males

TM no surgery- tx like female

TM top surgery- reduced risk, higher than males

35
Q

cervical cancer screening

transwomen

transgender men

A

transwomen- who had vaginoplasty may have risk of condyloma consider screening

transgender men- not at increased risk, q3-5y, will have atrophy

36
Q

transmen after hysterectomy

cervical ca screening

A

after hysterectomy- no paps
if no history of high grade dysplasia

if hx high grade- follow by gyn and onc

37
Q

can do a total hysterectomy if meet these three criteria:

A
  • no desire for pregnancy
  • older than 40
  • surgery will do no harm
38
Q

transmen have higher risk of:

A

PCOS (screen at least once)

chance of infertility, cardiac, HTN, endometrial cancer

39
Q

Prostate screening

transwomen no hormones

transwomen hormones

A

no hormones- PSA if high risk (AA) family hx (start at 45-50)

hormones- decreased risk prostate cancer, prostate is not removed must start digital exam 50

40
Q 
Health screenings for hormones
1)
2)
3)
4)
5)
A

cardiac- hormones, smokers, PCOS

lipids- testosterone

HTN- estrogen increases, testosterone unknown

DM- estrogen increases risk, PCOS (glucose intolerance) testosterone- decreased fat and glucose, increase insulin resistance
yearly screening

lipids- estrogen (inc HDL and triglycerides; decreased LDL) testosterone (decrease HDL increase LDL)

osteoporosis- estrogen good, transmen after ovary removal bone density decrease if testosterone not replaced properly to prevent LH

41
Q

transwomen with hyperlipidemia should use___

A

transdermal estrogen patch

42
Q

Conceiving after hormone

FTM

MTF

A

FTM- may be able to

MTF- sterile within a few months

43
Q

chest surgery criteria required prerequisite

MTF should take _______ prior to breast surgery

A

one referral mental health provider, hormone not prerequisite

-MTF should take feminizing hormone to increase breast tissue

44
Q

genital surgery criteria:

1) removal of sex organs:
2) rearranging surgery:

A

two mental health provider referals

removal of sex organs- 12 months continuous hormones

rearranging surgery- also 12 months living in gender full time

45
Q

MTF post surgical considerations

1)
2)
3)
4) pap?

A

intercourse or dilation of vagina

UTI

incontinence from nerve damage

pap if glans penis used to create cervix
if no new cervix- pap if history of genital warts

46
Q

FTM pap?

A

many will not have vaginectomy

atrophy because of testosterone- painful

Primary care II (13 decks)

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