Post-Test Multi choice questions

Estradiol valerate and hemihydrate as estrogen-only HRT are recommended in the UK as feminising endocrine therapy in this context.

Routine breast screening is required by all trans people who have breasts, including people who have undergone mammoplasty. For those who have a small amount of breast tissue following bilateral mastectomy with chest reconstruction surgery, routine breast screening is not usually required, but self-examination for lumps should be encouraged.

A person’s affirmed gender describes the gender status achieved after transition. This usually involves bringing their general appearance, name and pronouns into line with their gender identity.¹¹ Validity does not depend on any given transition process, and indeed not all gender diverse people require medical or surgical intervention in order to achieve it. Social transition usually involves a change of name and dressing/behaving in an affirmative way, and for some this can be sufficient. People with a non-binary gender identity (an identity that is neither exclusively male or female) may require a bespoke medical transition pathway, for example, low dose hormone or anti-androgen therapy, in order to achieve psychological and physical congruence.

Hypoactive sexual desire disorder is characterised by the loss of sexual fantasies and the desire for sexual intimacy. Due to the relative potency of GnRH agonist with regard to androgen suppression, this is occasionally reported. Treatment with add-back testosterone therapy can be offered with specialist guidance.

Nebido is the most commonly used long-term testosterone but is not recommended for the initiation of treatment. Sustanon is short-acting and therefore an appropriate starter therapy, but it does confer the highest rate of polycythaemia and mood variability. Testosterone gel is an alternative, offering more control and less of an impact on mood. Smoking cessation should have occurred for at least 3 months before treatment begins, and in this context NRT is considered a safe alternative to combusting tobacco.

Through its diuretic action, Spironolactone could under certain circumstances be a factor in the development of a DVT. Topical estradiol is not associated with a significantly increased risk of DVT.²² Finasteride lowers serum DHT (dihydrotestosterone) and for this reason helps protect against scalp hair loss.

A vulvo-vaginal swab might miss the focus of a mucosal infection, particularly if the vagina has been constructed from penile skin. In this scenario, a urine NAAT (urine nucleic acid amplification) test would be more likely to detect Chlamydia and Gonorrohoea.

Bilateral mastectomy with chest reconstruction surgery can be deployed as a gender affirmative intervention for people who do not use testosterone therapy. For people who do, treatment for a minimum period of 6-9 months is usually recommended in order for changes in the shape of the chest wall to have taken place, thus offering the best cosmetic result. The double-incision technique is most commonly used and usually leaves scarring along the contour of the pectoralis. Less dramatic is the peri-areolar technique, the incision limited to the areolar complex. However, this is only a possibility for candidates with a small breast volume. Surgery of any kind is not a requirement for a Gender Recognition Certificate. Smoking affects the integrity of micro-capillaries and is therefore associated with a higher rate of failure of free graft, including the nipples.