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WPATH GEI Day 1 4) Foundations in Primary Care WPATH GEI Day 3 13)…
WPATH GEI Day 1
4) Foundations in Primary Care
WPATH GEI Day 3
13) Advanced Primary Care
(Asa Radix)
Breast cancer screening
(No trans specific guidelines)
Follow that for cis women
Hormones: Duration, dosage…
Trans masculine
Trans men have poor experience in radiology - Explain to radiology
Top surgery: No MMG
No top surgery: same as cis women
Trans feminine
Implant: No MMG
Same as cis
Primary care
(Other gender-affirming services)
Post-op care
Documents
Mental, sexual, reproductive health
Preventive health screenings (various factors)
Chronic disease manamgement
Electronic medical records
Organ inventory - up-to-date (based on gender markers)
Regular reminders of cancer screening
Gender identity & assigned sex at birth
Overian & endometrial cancer
Testicular cancer
Routine screening not recommended for cis/trans people
Ovarian
Endometrial
Testicular
No evidence that on t increases the risks of ovarian cancer
No need routine USG (and traumatic)
No need routine hysterctomy (Old times it is purposefully doing sterilization of trans people)
Unexplained vaginal bleeding: Investigations
(May be lower t level)
Cervical cancer
(People with cervix)
Everyone needs HPV vaccine
Dysphoria
Bring their friends
Do they prefer a chaperone
Any sexual trauma
Ask earlier, have time to prepare
How they describe their body parts?
Do they prefer running commentary?
NO if you don’t do cervical cancer screening,
you don’t get testosterone
Vaginal atrophy
(Inadequate cytologic specimens)
Only do HPV testing (no affected)?
Given them estrogen???
Provider-collected?
Patient-collected?
Osteoporosis
ONLY androgen blocker at first
Lower BMD
Trans femme BEFORE starting GAHT
Lower BMD: Less exercises, outdoor
GAHT in adults is not associated with major bone loss
Estrogen: Higher BMD (clinical significance have lower fracture risks?)
Puberty blocker
Monotherapy GnRH agonist may lower BMD
Starting at age 65 (trans masc, trans femme) with DEXA
(Sooner with e.g. gonectomy and little hormones, HIV…)
Measure LH to monitor replacement to preserve bone mass
Mental health
PHQ-9: Validated for trans people
Names & pronouns: Better mental health
Smoking
(Trans: Highly prevalence: minority stress,
Higher health risks)
Ask everyone about tobacco use
Offer behavioral and pharmacotherapy
Prostate cancer
(Bottom surgery does not remove prostate)
Routine? Controversial
Shared decision making for cis/trans
If yes, in trans femme (already taking androgen blocker…)
Can be advanced when found
GAHT or removed testes may falsely decrease PSA levels
Over 1 is already high?
Multiply by 4?
Prostate examination
No evidence that estrogen increases the risk of prostate cancer
Colorectal cancer
Bottom surgery with colon
Colonoscopy + check neovagina
Anal cancer
(HIgher risks with anal receptive sex, HIV)
Mortality
(Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria)
2021, De Blok
Higher mortality than general population
Unrelated to hormones e.g. suicide, cardiovascular risks
Chronic disease management
Cardiovascular diseases
(Limited data)
Other factors (not just hormones!)
VTE
Hypertenion
Dyslipidemia
Diabetes
10 year CVD risks
Sex?
Use the worse score? Considering minority stress?
Shared decision making
Tailored risk assessment
Sexual and reproductive health
HIV screening for everyone (opt out)
HIV prevalence in trans women: 19.9%
(66% higher than general population)
HIV prevalence in trans men: 2.56%
3 sites (genital, mouth, anal)
8P: Comprehensive sexual history
Asking permission (they can refuse)
May have sexual trauma
Be aware of their body language
Ensuring that PrEP does not affect hormone levels
No studies for AFAB for other meds :cry:
Theoretically 2-1-1 has sufficent level for everyone’s anus, includnig AFAB people
Pregnancy
GAHT is not contraception
Pregnancy: Contraindicaton of testosterone
Can use all types of contraception
Hair removal prior to vaginoplasty/phalloplasty
