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Flashcards in Care of Trans Patients Deck (20)
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1
Q

Indications for mammography screening in trans women

A

screen if:

  • > 50yo + hormone tx hx
    • additional risks: fhx, obesity, estrogen and progestin use > 5 yrs
2
Q

Osteoporosis screening rx for transmen

A
- Bone density at age
60 or earlier based
on risk factors
- Consider in those
not compliant with
hormone therapy
3
Q

Osteoporosis screening rx for transwomen

A
- Bone density at age 60
or earlier based on risk
factors
- Consider in those not
compliant with hormone
therapy
4
Q

Breast cancer screening @ transmen

A
-Perform chest wall
examination after
chest surgery
-otherwise mammography
as recommended for
cisgender women
5
Q

Main principles for gender-affirming hormone therapy

A
  1. reduce endogenous
    hormone levels and their associated sex characteristics
  2. replace with hormones of the preferred sex
6
Q

Risks with estrogen therapy

A
  • thromboembolic disease (~2-6%); decreased w/transdermal
  • coronary artery disease
  • cerebrovascular disease
  • severe migraine headaches
  • liver dysfunction
  • macroprolactinoma
  • increased insulin resist/Fast BG
  • increased triglyceride
7
Q

Risks with testosterone

A
  • erythrocytosis (HCT > 50%)

- increased insulin resist/Fast BG

8
Q

Goal hormone levels for transwomen

A

-estrogen @ normal range for
cisgender women of reproductive age (< 200
pg/mL)
-testosterone levels should be suppressed < 55 ng/dL

9
Q

Goal hormone levels for transmen

A

-Goal testosterone =
320 - 1,000 ng/dL measured
at intervals specific to the preparation used
(ie, midway between injections for tx w/ Test cypionate).
-Estradiol levels < 50ng/dL

10
Q

Lab monitoring for transwomen

A
  • estradiol/testosterone q3mo x 1 yr, then q6-12 mo after goal
  • serum prolactin prn sx of prolactinoma
  • serum electrolytes w/spironolactone
11
Q

Lab monitoring for transmen

A
  • estradiol/testosterone, +/- SHBG/albumin (for testosterone bioavailability) q3mo x 1 yr, then q6-12 mo after goal
  • CBC, LFTs q3mo x 1yr, then q6-12 months
12
Q

Physical changes timeline for transwomen on hormones

A
  • decreased libido/spontaneous erections for first 3 mo

- breast growth @ 3-6mo

13
Q

Physical changes timeline for transmen on hormones

A
  • fat redistribution first 6 mo
  • facial/body hair slow x up to 4-5 yrs
  • amenorrhea @ 1-6 mo
14
Q

Types of hormones used in gender-affirming therapy for transwomen

A
  • estrogens (estradiol or 17-beta-estradiol)
  • progesterone
  • androgen blockers (sprio, 5-alpha-reductase inhibitors e.g. finasteride, dustasteride)
15
Q

Estrogen formulations

A
  • oral/SL (daily, TDD>2mg = BID dosing)
  • transdermal (patch) - frequency depends on formulation
  • injection (estradiol valerate IM, estradiol cypionate IM) q2wk dosing (can go weekly if cyclical sx)
16
Q

Progesterone formulations

A
  • oral, QHS dosing
  • medroxyprogesterone acetate (provera)
  • micronized progesterone
17
Q

Anti-androgen medication classes

A
  • spironolactone (main SE is hyperK, can have diuresis, orthostasis)
  • 5-alpha-reductase: finasteride, dustasteride
  • other anti-androgens not used in US: cyproterone acetate (assoc w/fulminant hepatitis), bicalutamide (risk to liver, fulminant hepatitis)
  • (if unable to suppress/work-up negative): GnRH analogs = leuporelin (Lupron), triptorelin (Decapeptyl)
18
Q

Work-up for persistently elevated testosterone in transwomen

A
  • adherence/access
  • exogenous testosterone use
  • eval for testicular neoplasm: scrotal exam, hcg, LDH, AFP, +/- scrotal imaging
19
Q

Management of persistently elevated testosterone in transwomen

A
  • work-up for exogenous testosterone source
  • GnRH analogs
  • orchiectomy
20
Q

Lab monitoring to ensure adequate bone density maintenance

A

LH/FSH suppression can be used as a surrogate marker (in addition to clinical effect/testosterone levels) that indicates adequate sex hormone levels for maintaining bone density