Primary Care and Hormonal Treatments for ….pptx

Primary Care and Hormonal Treatments for Transgender PatientsNick Gorton, MD, DABEMnick@lyon-martin.orgDefinitionsGender – masculine, feminine, androgynousSex – male, female, intersex, transsexual* Non BinaryDefinitionsGender IdentityGender ExpressionDefinitionsCisgenderCissexualTransgenderTranssexualCisgender/CissexualTransgenderTranssexualDefinitionsFTMMTFThe Two CommandmentsThe Two CommandmentsPrimary Care and Hormone TherapyYou already know 90% of what you need to knowMost medical care of transgender patients has nothing to do with being transgender100% of the medical treatments and most of the surgeries are used in cisgender patientsThe HandoutHow does this work?Typical Narrative...Accept your own trans identity and seek helpInternet, local groups, organizationsFind a therapist and receive a dx (and letter)3 month Real Life ExperienceORPsychotherapy (duration TBD, usually 3+months)Find a medical providerStart hormone therapyNon-genital surgery (same time as HRT)1 year successful – genital surgeryTypical Narrative (following SOC)Does everyone do it this way?If they dont should you still treat them?Harm ReductionWPATH-SOC explicitly endorse harm reductionMedical Treatments: FundamentalsSet realistic goalsWhat will, might, and wont happenEmphasize primary and preventative careUse the simplest hormonal program that will achieve goalsEvery option doesnt work for every patientCost, ease of use, safetyMedical Treatments: FundamentalsPatience is a virtuePuberty comparisonSide effects are in the eye of the beholderBaldnessMedical Treatments: FundamentalsHormone treatments are one of the easiest partsFTM – Testosterone up to normal male doseDose that masculinizes and stops menses is enoughMTF – More difficult because must suppress testosterone production to get best resultsAnti-androgen(s)EstrogensMedical Treatments: MTFEstrogens at high dose3-5x normal replacement dosesEstrogen Supresses Testosterone!Anti-AndrogenSpironolactone and othersOrchiectomyResults variableAge