transgender health

define gender

a social construct that reflects how a person identifies

gender is part of someones ____ sense of self

internal, it can be male, female, neither, a mix of both

T/F a persons relationship with their gender can change over time

true

what is non-binary

gender that doesn’t fit into male or female

what is cisgender

gender assigned at birth is the one you identify as

changing the way we use which bathroom is an example of?

social transitioning

what are some examples of physical transitioning

make-up, hair, clothes, hormones, surgery

what is gender dysphoria

intense discomfort a trans person may feel regarding physical attributes or the way they are gendered by others- can be physical, social or emotional

what is gender fluid?

a person whose internal gender identity is not fixed and can shift or change over time

what is gender incongruence vs gender dysphoria

what is transman

registered female at birth, moved to masculine identity

can someone under the age of 18 be on puberty blockers

yes, if both parents and doctor are on board AND patient has gillick competence (puberty blockers does not need), pt needs diagnosis of gender dysphoria. if parents don’t agree = FCWA

presentation of Gender dysphoria and ASD can NOT complicate assessment (T/F)

false

changing pronouns, changing the name they use, changing sex on legal documents, wearing clothes in accordance with gender identity are all forms of?

social transition

what medication is used in puberty suppression

GnRH agonist’s

how does GnRHa work in puberty suppression

prevents further development of endogenous secondary sex characteristics corresponding for registered sex at birth.

when should GnRHa have the best effect

tanner stage 2-3

what is the purpose of puberty suppression

extends time for adolescents decisions on irreversible treatments

what is an unintended consequence from GnRHa treatment

decreased BMD

what medications are used for puberty suppression

goserelin implant, leuprorelin injection, triptorelin injection - not PBS subsidised

what to monitor if on puberty suppression medications

BMI, BP, Tanner stage, FBE, LFT, Side effects, LH + FSH at 6 months

What does GAHT stand for?

Gender affirming hormone therapy

which hormones would we give for males registered at birth undergoing GAHT

Oestrogen, Anti-androgens, progestogens (evidence?)

which hormones would we give for females registered at birth undergoing GAHT

testosterone

if someone is on puberty suppression and is wanting GAHT, how do we start it?

continue GnRHa for 6 months when starting GAHT, Do not start anti-androgens while taking GnRHa

dose of estradiol valearate for GAHT- how much do we aim for?

1mg od for 6-12months. Aim for 300-600pmol/L estradiol trough

transdermal estradiol therapy has a lower ___ risk

VTE

what would we start seeing after 1-3 months of oestrogen therapy

softening of skin, reduction in muscle mass, increase in body fat + redistribution to the hips, decreased sex drive, fewer morning erections, difficulty getting firm erections even when aroused, decreased ability to make ejaculatory fluid

what would we start seeing after 3-6 months of oestrogen therapy

decreased testicular size

what would we start seeing after 1-2 years of oestrogen therapy

nipple and breast growth (irreversible), slower growth of facial and body hair, slowed/stopped balding

how to move within dosage forms (eg. if want to move from patch to tablet use same column)

ok

which anti-androgens complement oestrogen therapy in GAHT in AUS

Cyproterone (more potent) + Spironolactone —> can stop errections (might not be desired)

dose of cyproterone as anti-androgen GAHT

12.5mg alt days to 25mg od

dose of spironolactone in GAHT

100mg od to 200mg bd

Why can’t we used anti-androgens as GAHT monotherapy

can cause osteoporosis without oestrogens, not necessarily feminising (doesn’t cause patient to look more female)

T/F: Cyproterone / Spironolactone CAN exacerbate depression + fatigue

true

what would we start seeing after 1-3 months of anti-androgen therapy

reduced sex drive, improved acne, fewer morning erections, difficulty getting erections even when aroused, decreased ability to make sperm/ ejaculatory fluid

what would we start seeing after 2+ years of anti-androgen therapy

slowed/ stopped balding, slight breast growth (sometimes reversible), slower growth of facial and body hair

what would we start seeing after 1-3 months of testosterone therapy

increased sex drive, vaginal dryness (tx with vagifem low/ ovestin), growth of clitoris- irreversible, thick body hair growth, increased acne, increased muslce mass and upper body strength, redistribution of body fat from hips to waist

what would we start seeing after 1-6 months of testosterone therapy

menstrual periods stop

what would we start seeing after 3-6 months of testosterone therapy

deepened voice, vaginal atrophy

what would we start seeing after 1+ years of testosterone therapy

growth of facial hair (irreversible), possible male balding

ongoing monitoring during GAHT

ok

does testosterone therapy mean that you can’t get pregnant?

No! can still get pregnant. LNG-IUD, Implanon, DMPA, OCP, tubal ligation (permanent) are options. trans women may need to use barrier methods or vasectomy

what are some preservation options for fertility considerations

freezing sperm/ eggs, freezing embryos, if before puberty = testicular/ ovarian tissue cryopreservation

can transmen use the Plan-B pill if required?

yes, will not affect GAHT

_____ therapy can improve dry eye and retinal blood flow

estrogen

can surgeries happen in patients under 18 in Aus

No- exception of chest reconstructive surgery

electrolysis is preferred to laser hair removal (T/F)

true

main reason for detransitioning is

family/social/economic pressure