1/10/2018
DISCLAIMER
• I have no conflicts of interest or financial disclosures FROM BRUCE TO CAITLYN: TRANSGENDER MEDICINE IN 2018 David Newman, MD
ANOTHER DISCLAIMER
• This presentation WILL NOT discuss the ethics of transgender medicine. Regardless of your stance on the subject, you will encounter patients on hormonal therapy and need to know about the treatment, side effects, and long term health maintenance.
WHY DISCUSS TRANSGENDER MEDICINE?
1 1/10/2018
GENDER IDENTITY 3 AREAS TO TREAT
• Psychosocially
• The inherent sense one has of being male or female • Hormonally
• Anatomically
HORMONAL TREATMENT: BASIC REFRESHER FTM
• Testosterone
• Intramuscular
• Topical
• Implantable pellets http://openi.nlm.nih.gov/imgs/512/123/3540953/3540953_ott-6-009f1.png
WHAT TO EXPECT: FTM
Onset Maximum Effect (months) (years) Skin oiliness/acne 1 - 6 1 - 2 Facial/body hair growth 6 - 12 4 - 5 Scalp hair loss 6 - 12 Increased muscle mass/strength 6 - 12 2 - 5 Fat redistribution 1 - 6 2 - 5 Cessation of menses 2 - 6 Clitoral enlargement 3 - 6 1 - 2 Vaginal atrophy 3 - 6 1 - 2 Deepening of voice 6 - 12 1 - 2
https://parkerkierce.wordpress.com/tag/hrt/
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SURGICAL CHAZ BONO REASSIGNMENT: FTM
• Mastectomy
• Hysterectomy and bilateral salpingo- oophorectomy
• Addition of phallus
http://www.timetobreak.com/147711/13-famous-transgender-celebrities/4/
COMPLICATIONS: FTM
• Heart Disease: uncertain
• Breast, uterine, and ovarian cancer: uncertain, but possibly increased
• Erythrocytosis
• LFT abnormalities
http://www.fastbleep.com/assets/notes/image/7055_1.jpg
HORMONAL TREATMENT: WHAT TO EXPECT: MTF MTF Effect Onset Maximum • Spironolactone —> blocks synthesis of Redistribution of body fat 3 - 6 months 2 -3 years Decrease in muscle mass and 3 - 6 months 1 - 2 years testosterone and androgen receptor strength Softening of skin/decreased 3 - 6 months unknown oiliness • Estrogen Decreased libido 1 - 3 months 3 - 6 months Decreased spontaneous 1 -3 months 3 - 6 months erections Male sexual dysfunction Variable Variable • Oral Breast growth 3 - 6 months 2 - 3 years Decreased testicular volume 3 - 6 months 2 - 3 years Decreased sperm production Unknown > 3 years • Patch Decreased terminal hair growth 6 - 12 months > 3 years Scalp hair No regrowth Voice changes None
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ISIS KING
http://www.timetobreak.com/147711/13-famous-transgender-celebrities/2/
http://i.imgur.com/BS0ad27.jpg
SURGICAL LEA - T REASSIGNMENT: MTF
• Vaginoplasty
• Facial feminization
• Vocal cord surgery
• Breast augmentation
• Tracheal shave
http://www.timetobreak.com/147711/13-famous-transgender-celebrities/7/ • Buttock augmentation
COMPLICATIONS: MTF
• Venous thromboembolism: presumed increase
• Discontinue estrogen three to four weeks before surgery
• Coronary Artery Disease
• Familial hypertriglyceridemia
• Mortality: Increased (no adjusted data)
• Elevated prolactin
https://gendertrender.files.wordpress.com/2014/08/srs-male.jpg • Electrolyte issues
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HEALTH MAINTENANCE WHAT SHOULD I DO?
• Bone Density • What would you do for any other patient of their age? • Prostate • Referral to psychology • Mammograms
• • HIV Routine Health Maintenance
• Cervical/Uterine/Ovarian Health • Refer as necessary
• Fertility • Be aware of complications
QUESTIONS?
5