Podcast
Questions and Answers
Which of the following best describes why spironolactone is used in feminizing hormone therapy?
Which of the following best describes why spironolactone is used in feminizing hormone therapy?
- It functions as an androgen receptor antagonist, inhibiting testosterone signaling. (correct)
- It increases gonadotrophin secretion, which indirectly lowers testosterone levels.
- It acts as an aldosterone agonist, reducing fluid retention.
- It directly stimulates estrogen production, enhancing feminization.
Which statement accurately describes the role of GnRH agonists like leuprolide in feminizing hormone therapy?
Which statement accurately describes the role of GnRH agonists like leuprolide in feminizing hormone therapy?
- They suppress testosterone levels by inhibiting gonadotrophin secretion. (correct)
- They enhance the effects of androgens, promoting masculinization.
- They directly convert testosterone into estrogen.
- They increase the risk of thromboembolism, especially when combined with ethinyl estradiol.
Why is 17-beta-estradiol favored over synthetic estrogens like ethinyl estradiol in current feminizing hormone therapy standards of care?
Why is 17-beta-estradiol favored over synthetic estrogens like ethinyl estradiol in current feminizing hormone therapy standards of care?
- It is more effective at suppressing testosterone levels.
- It does not require the addition of anti-androgen medications.
- It can be administered at lower doses with similar effects.
- It has a lower risk of thromboembolism. (correct)
Which of the following is the primary goal of feminizing hormone therapy?
Which of the following is the primary goal of feminizing hormone therapy?
Which route of administration of 17-beta-estradiol is reported to achieve higher median estradiol blood levels?
Which route of administration of 17-beta-estradiol is reported to achieve higher median estradiol blood levels?
What is the typical plasma target concentration range aimed for in masculinizing hormone therapy?
What is the typical plasma target concentration range aimed for in masculinizing hormone therapy?
A transgender man is prescribed testosterone enanthate. What is the typical method of administration and frequency for this medication?
A transgender man is prescribed testosterone enanthate. What is the typical method of administration and frequency for this medication?
A patient undergoing feminizing hormone therapy with spironolactone reports increased thirst and frequent urination. Which mechanism of action of spironolactone is most likely related to this side effect?
A patient undergoing feminizing hormone therapy with spironolactone reports increased thirst and frequent urination. Which mechanism of action of spironolactone is most likely related to this side effect?
Which of the following is the primary goal of masculinizing hormone therapy?
Which of the following is the primary goal of masculinizing hormone therapy?
Which of the following is NOT a typical route of testosterone administration for masculinizing hormone therapy?
Which of the following is NOT a typical route of testosterone administration for masculinizing hormone therapy?
Which mechanism describes how spironolactone impacts hormone levels in feminizing hormone therapy?
Which mechanism describes how spironolactone impacts hormone levels in feminizing hormone therapy?
Why is continuous administration important for leuprolide's effectiveness in feminizing hormone therapy?
Why is continuous administration important for leuprolide's effectiveness in feminizing hormone therapy?
Which of the following is a rationale for using 17-beta-estradiol over synthetic estrogens in feminizing hormone therapy?
Which of the following is a rationale for using 17-beta-estradiol over synthetic estrogens in feminizing hormone therapy?
What is the rationale behind monitoring plasma testosterone levels in transgender men undergoing masculinizing hormone therapy?
What is the rationale behind monitoring plasma testosterone levels in transgender men undergoing masculinizing hormone therapy?
A transgender man on testosterone therapy reports increased aggression and mood swings. What initial step should be considered in managing this side effect?
A transgender man on testosterone therapy reports increased aggression and mood swings. What initial step should be considered in managing this side effect?
Why are anti-androgen medications typically included in feminizing hormone therapy?
Why are anti-androgen medications typically included in feminizing hormone therapy?
What is a key consideration when choosing between different forms of testosterone esters (enanthate, cypionate, undecanoate) for masculinizing hormone therapy?
What is a key consideration when choosing between different forms of testosterone esters (enanthate, cypionate, undecanoate) for masculinizing hormone therapy?
Which observation supports the finding that spironolactone is effective at decreasing testosterone levels?
Which observation supports the finding that spironolactone is effective at decreasing testosterone levels?
A transgender man using transdermal testosterone reports inconsistent absorption. What is an appropriate alternative?
A transgender man using transdermal testosterone reports inconsistent absorption. What is an appropriate alternative?
What is the primary mechanism by which leuprolide suppresses testosterone production?
What is the primary mechanism by which leuprolide suppresses testosterone production?
Flashcards
Feminizing Hormone Regimens
Feminizing Hormone Regimens
Hormone therapy to create a more feminine appearance.
17-beta-estradiol
17-beta-estradiol
Estrogen that enhances the female phenotype in feminizing hormone regimens.
Spironolactone
Spironolactone
Medication added to feminizing hormone therapy for testosterone suppression.
GnRH agonists
GnRH agonists
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Masculinizing hormone therapy
Masculinizing hormone therapy
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Masculinizing Regimens
Masculinizing Regimens
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Target Testosterone Levels
Target Testosterone Levels
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Gender-Affirming Hormone Regimens
Gender-Affirming Hormone Regimens
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Testosterone Administration
Testosterone Administration
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Study Notes
Adult Gender-Affirming Hormone Regimens
- The lecture covers the principal drugs and strategies used in feminizing and masculinizing hormone regimens
Feminizing Hormone Regimens
- Standards of Care for the Health of Transgender and Gender Diverse People recommend testosterone-lowering medications or GnRH agonists for transgender people with testes taking estrogen
- These treatments aim to approximate sex hormone levels found in cisgender women
- The most commonly prescribed feminizing hormone drug regimens include 17-beta-estradiol, spironolactone (anti-androgen), and/or leuprolide (GnRH agonist)
17-beta-Estradiol
- Estrogen therapy enhances the female phenotype, supporting breast development and female-typical fat distribution
- Estrogen can also suppress testosterone, but not always to the levels found in cisgender women
- 17-beta-estradiol is the recommended estrogen in current standards of care
- Synthetic estrogens like ethinyl estradiol carry an increased risk of thromboembolism
- Oral 17-beta-estradiol (2-6 mg/day) and IM injections (>10mg/week) are common among transgender women
- Intramuscular delivery can achieve higher estradiol blood levels compared to oral or transdermal methods
Spironolactone (Anti-Androgen)
- Anti-androgen medications are needed to inhibit testosterone signaling in feminizing hormone therapy
- Estradiol is usually combined with androgen suppressive therapy in the USA, usually spironolactone
- Spironolactone, an aldosterone antagonist, can bind to the androgen receptor and function as an androgen receptor antagonist
- In one study, transgender women (n=98) treated with oral spironolactone and estrogen saw median testosterone levels drop from 385 ng/dL initially to below 130 ng/dL within 12 months
GnRH Agonists (Anti-Androgens)
- A mainstay in feminizing hormone regimens involves suppressing endogenous testosterone production to reduce male characteristics
- GnRH agonists, like leuprolide, reduce testosterone levels
- Leuprolide acetate is a synthetic analogue of GnRH that acts as an inhibitor of gonadotrophin (LH/FSH) secretion when consistently administered
- Lower LH/FSH levels suppress testosterone biosynthesis
- One pilot study suggests that monthly leuprolide acetate IM injections combined with transdermal estradiol was effective in suppressing gonadotrophins and testosterone levels over a year
Masculinizing Hormone Regimens
- Largely rely on testosterone administration
- Administered via intramuscular injection (testosterone esters like T enanthate, T cypionate, or T undecanoate) or transdermally (patch or gel)
- Plasma target concentrations are 260-920 ng/dL which are the normal testosterone range for non-obese European and American men aged 19-39
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