RESidENcy PROGRAM Scholarly and Community Medicine Projects
RESidENcy PROGRAM Scholarly and Community Medicine Projects
RESidENcy PROGRAM Scholarly and Community Medicine Projects
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Psychological Assessment cont’d<br />
I need a letter which provides psychological clearance for @FNAME@ to<br />
start hormonal therapy for gender transition. This letter should<br />
include the following:<br />
� Confirmation of diagnosis of gender identity disorder<br />
� Assessment of pt's mental health (i.e. is it stable or improving)<br />
� Assessment of pt's ability to take hormones in a stable manner<br />
� Assessment/discussion of pt's expectations regarding hormone<br />
therapy<br />
� Assessment of any other pschological comorbidities<br />
If *** is not able to provide a letter of clearance, pt will be referred to<br />
Pathways Counselling center in Milwaukee.<br />
Male to Female<br />
Medications<br />
Hormone Therapy<br />
Estrogen: 17B 17B-estradiol estradiol<br />
Transdermal Oral<br />
use if if >40 >40 yrs, yrs, or or at at risk risk If If < < 40 40 yo yo <strong>and</strong> <strong>and</strong> lo lo risk risk<br />
for for DVT DVT<br />
for for DVT DVT<br />
BBr<strong>and</strong> dNName Climara Climara, Vivelle Vivelle, Estradot Estrace<br />
Preorchiectomy<br />
Postorchiectomy<br />
Start 0.1mg/24hrs, twice<br />
weekly; gradually increase<br />
to max 0.2mg/24 hrs twice<br />
weekly<br />
0.375-0.1mg/24 hours,<br />
Applied twice weekly<br />
Start 1-2mg daily,<br />
increase to maximum<br />
4mg daily<br />
1-2mg daily<br />
Monthly Cost $31-60/month generic $11-$18/month generic<br />
Overview<br />
Responsibilities of prescribing clinician (per WPATH):<br />
1. Perform an initial evaluation (H&P, labs)<br />
2. Explain what the hormones do <strong>and</strong> possible side effects/health risks<br />
3. Confirm the pt has the capacity to underst<strong>and</strong> risks/benefits <strong>and</strong><br />
make an informed decision<br />
4. Inform pt of WPATH SOC <strong>and</strong> eligibility/readiness requirements<br />
5. Provide ongoing medical monitoring, including regular physical<br />
exams <strong>and</strong> monitoring labs<br />
Male to Female<br />
Timeline<br />
� 1-6 mos: body fat redistribution, decreased muscle<br />
mass, softer skin, decreased libido, anorgasmia,<br />
decreased ejaculate, decreased erections, testicular<br />
atrophy<br />
� 1-2 mos: breast buds<br />
� Years: hair is finer <strong>and</strong> grows more slowly<br />
Male to Female<br />
Medications (cont’d)<br />
Spironolactone Finasteride<br />
Br<strong>and</strong> Name Aldactone Proscar<br />
Pre-<br />
orchiectomy hi t<br />
Postorchiectomy<br />
Monthly Cost<br />
Start 50-100 daily, 2.5-5.0 mg daily for<br />
increase by 100mg each<br />
month to maximum<br />
systemic anti-<strong>and</strong>rogen<br />
effects<br />
300mg/day (some say 500 2.5 mg every other day if<br />
mg max)<br />
Modify if risk factors<br />
solely for alopecia<br />
<strong>and</strong>rogenetica<br />
0-50 mg daily 2.5 mg daily<br />
200mg daily = $70/month<br />
25mg tabs are on the $4 list<br />
5mg daily-$70/month<br />
5mg tabs are on the $4 list<br />
5/13/2011<br />
6
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