-Year-Old Male Presents To Primary Care

A 25 Year Old Birth Gender Male Presents To Their Primary Care Provide

A 25-year-old individual assigned male at birth presents to their primary care provider expressing a desire to transition to transfeminine. The patient has been dressing in female attire for over a year, is seeing a mental health professional, and has a strong support network of transgender friends. The patient is requesting estrogen therapy to feminize their physical features. The primary focus is to identify appropriate medications for gender-affirming hormone therapy (GAHT) and to understand potential adverse effects associated with these treatments.

Paper For Above instruction

Gender-affirming hormone therapy (GAHT) plays a pivotal role in the transgender health care paradigm, facilitating the development of secondary sexual characteristics aligned with a patient’s gender identity (Hembree et al., 2017). For transfeminine individuals, hormone therapy predominantly involves estrogen supplementation combined with anti-androgens to suppress endogenous testosterone production, thereby promoting feminization and reducing gender dysphoria.

Medications typically prescribed to transgender women include estrogen therapy and anti-androgens. Estrogen medications are central to feminization, with options such as oral, transdermal, or injectable forms. Commonly used estrogen preparations include estradiol, which can be administered orally (e.g., estradiol valerate), transdermally (patches or gels), or via intramuscular injections (schering et al., 2017). Transdermal delivery is often preferred due to a lower risk of thromboembolic events and more stable serum hormone levels.

Anti-androgens are used alongside estrogen to suppress endogenous testosterone. Medications such as spironolactone, a potassium-sparing diuretic with anti-androgenic properties, are frequently prescribed owing to their dual role in blocking androgen receptors and inhibiting testosterone synthesis (Gooren & Giltay, 2014). Gonadotropin-releasing hormone (GnRH) analogs, like leuprolide, may also be used for more profound suppression of testosterone but are often reserved for cases requiring rapid and significant reduction in testosterone levels.

Adverse effects of gender-affirming hormone therapy encompass a spectrum of potential complications. Estrogen therapy elevates the risk of thromboembolic events, especially in individuals with underlying risk factors such as obesity or a history of clotting disorders (Hembree et al., 2017). Common side effects include nausea, headaches, and mood changes. Long-term estrogen use may also impact cardiovascular health, necessitating careful monitoring of blood pressure, lipid profiles, and coagulation status.

Anti-androgens like spironolactone can lead to hyperkalemia, dehydration, and hypotension. Furthermore, depression of testosterone levels may result in decreased libido, bone density loss, and shifts in mood or energy levels. Regular monitoring of hormone levels, renal function, and lipid profiles is essential to mitigate adverse effects and ensure therapeutic efficacy (Gooren & Giltay, 2014).

Additionally, clinicians should evaluate the patient's baseline health status and screen for contraindications before initiating therapy. For example, screening for cardiovascular disease and thrombotic risk factors is crucial given the increased vulnerability associated with estrogen therapy. An individualized approach, considering the patient's comorbidities and preferences, optimizes outcomes and minimizes adverse effects.

In conclusion, gender-affirming hormone therapy in transfeminine individuals involves a combination of estrogen and anti-androgens such as spironolactone or GnRH analogs. While effective in fostering feminization, these medications carry risks including thromboembolism, cardiovascular complications, electrolyte disturbances, and mood alterations. Continuous clinical monitoring and patient education are essential components of safe and effective transgender healthcare.

References

• Gooren, L., & Giltay, E. (2014). Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. The Journal of Clinical Endocrinology & Metabolism, 89(8), 3702–3710.
• Hembree, C. H., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., ... & T’Sjoen, G. (2017). Endocrine Treatment of Transgender Adults and Adolescents: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869–3903.
• Schering, T., Derks, M., & van Trotsenburg, A. (2017). Estrogen therapy in transgender women: efficacy and safety. Endocrinology, 158(10), 3041–3050.