Pre-Test Multi Choice Questions
1. Recommended HRT for trans women, include:
A and D
Elleste Duet (estradiol + norethisterone)
Estradiol hemihydrate
A and C
Estradiol valerate
Ethinylestradiol
2. At menopausal age, trans women:
could reduce their HRT dose to maintain serum estradiol approx. 200pmol/l
If HRT dose reduction is requested or required, it is broadly accepted that maintaining a serum estradiol level of approximately 200pmol/L should be sufficient to maintain feminisation and bone health. Ageing can present a challenge for gender diverse people, particularly with regard to losing control over appearance, dress and identity should they become reliant on others for self-care. 20 Living with dementia can cause some people confusion between their gender preference and their birth assignation.21
should aim to discontinue their HRT regime
could reduce their HRT dose to maintain serum estradiol approx. 650pmol/l
should consider combination HRT
3. Regarding gender diverse people accessing the National Breast Screening programme:
none of the above
this is not usually required for people who have undergone chest surgery
this is required by all
this is not usually required for people on testosterone therapy
this is only required for those trans women with a significant genetic risk
4. A person with a non-binary gender identity might affirm their gender through:
all of the above
counselling
chest surgery only
anti-androgen only
low dose estradiol or testosterone
A, and D
5. GnRH agonist injection in trans women using estradiol can be associated with:
hypoactive sexual desire disorder
initial menopausal symptoms including hot flushes
transient reduction in bone density
thromboembolism
all of the above
6. Max is 39 and was assigned female at birth. He identifies as a trans man and wishes to medically transition having recently been endorsed for hormone therapy by a NHS Gender Identity Clinic. Considering options for initiation of testosterone treatment:
Sustanon has the highest rate of associated polycythaemia but could be considered as short-term starter therapy
Nebido is most commonly used
Nicotine replacement therapy is contraindicated
Testosterone gel applied daily can be associated with wide variation in mood
B, and D
7. Polycythaemia associated with exogenous testosterone use:
requires cessation of testosterone treatment until resolution
is caused by testosterone inhibiting erythropoietin production
is compounded by smoking
is usually defined as haemoglobin >185 g/L and/or HCt >0.52
B and C
8. Charlotte changed her name using a deed poll and lives as a woman in all aspects of her life. She has been on the waiting list for some time, and in the past 6 months decided to start self-medicating. She was using Progynova 4mg and Spironolactone 100mg daily, purchased on the black market. She found the feminising effects extremely positive.
During the Summer break from University she developed a DVT and is now anti-coagulated. She has a good understanding of the risks involved and now buys estradiol patches.
You agreed to prescribe Finasteride as a safer oral anti-androgen alternative to Spironolactone. Looking at her treatments:
A, and C
Spironolactone may have contributed to the thrombotic event
Finasteride reduces serum testosterone but has no impact on DHT (dihydrotestosterone)
topical estradiol is not associated with a significantly increased risk of DVT
all of the above
9. If a trans woman who has undergone vaginoplasty develops symptoms of STI, a vulvo-vaginal swab is sufficient for detection of Chlamydia and Gonorrhoea:
False
True
10. Pertaining to bilateral mastectomy with chest reconstruction surgery:
smoking is associated with higher risk of free graft nipple loss
this is a gender affirming intervention available on the NHS exclusively to trans masculine people using testosterone therapy
it is a requirement for a Gender Recognition Certificate under the Gender Recognition Act 2014
the peri-areolar technique is most commonly used
at least two years of testosterone therapy is a pre-requisite
none of the above
all of the above