Transgender (Gender dysphoria)

(I)Becareful:
 How do you want me to call you ?
 Pronoun? He or She??
(II)Respect patient wishes:

To change the sex indicated on the medical records right away

, you don’t have to wait for gender recognition certificate

(III)Unlawful:

To disclose their gender history, only if it is relevant

(gynecology)

(IV)If by accident:

You mis-gender someone just apologize

Points not to miss in hx

MOOD

Support System:

If a child or Adult living with parents (social services)

How things at home

P2: Medical conditions (PE)

P3: DESA (smoking)

MAFTOSA
Medication FH of PE / cervical cancer

Management
Gender Dysphoria:

If the patient is requesting ttt for gender dysphoria refer to

Gender Identitiy clinic or gender specialist without a delay

All FY2 (GP):

Refer patients who want ttt to the GIC and not to the mental
health service before hand ((the longer the process the more
the risk of suicide))

Medicine:

Most of medications used for the pt are not liscenced for this
specific reason

Oesterogen?? VVVVimp

Discuss side effects and complications, failure risks and other

risks before prescribing to help them to make their mind

You have to take into condideration (suicide)

Outcome of doing nothing before side effects and

complications and giving specific medication

You may consider discussing effect of the tt on their

reproductive system before starting

Consider storage of eggs or sperms

Council then :

On the one hand your referral may take long time up to 2 yrs,
so you have to bear us, on the other hand that shows that’s a
larger amount of people just like you, you are not alone.
The risk of self harm and suicide is higher in trans-people than
general population.

Self medications (as it is taking long time to get their

medication ):

Speak to them and try to explain the risks and their point of
view about self medications

Bridging prescription:

The risk of harm to your patient of self medication with

hormones brought from unregulated source is greater than
the risk of initiating hormone therapy before assessment by
the specialistbut you should do blood tests and health checks
(Harm reducing Approach )

Do this if the patient met the criteria

1- Patients with self medications or likely to self prescribe

2- Bridging prescribtion instiated to diminish the risk of self
harm
3- GP has taken the advice of gender specialist and prescribe
the lowest acceptable dose

Safety netting:
Follow up in the primary care for hormone prescribing or
hormone monitoring

Under 16 GIDS
((Gender ID development service)) Child psychiatrist,
Social workers, endocrinologists, local child & adolescent
mental health service
 Cervical screening
Lesbian refusing cervical screening ((All females 25-64 will be
screened regardless their sexual orientation))
WHY ???
1- Most of them because they don’t have sex with a man ?
a- Take sexual history about her being heterosexual then
lesbian as papilloma virus could have been transmitted
previously
b- Eventhough research suggest that HPV more easily
passed through heterosexual intercourse it can also be
transmitted through lesbian intercourse (through body
fluids)
Oral sex
Vaginal fluid on hands or finger
Sexual toys sharing
Smoking (non sexual)
2- If she has ever had a screening if so any pain or challenges
?? ((Address concerns))
3- Rape :
If she has been ever forced to have sex

Take Hx:
P1: symptoms of cervical cancer
Bleeding between periods
Bleeding during or after intercourse
After menopause
Any unusual vaginal discharge
FLAWS
P2: Medical conditions
P3: DESA + sexual hist (toys)
 MAFTOSA
Medication risk factor family hist of cervical cancer

Remember
You shouldn’t ask about sexual orientation
during app. But ask about contraception
1- All individuals aged 25-64 who have a cervix are eligible
for cervical screening
2- Nearly all cases of cervical cancer are associated with
HPV which is sexually transmitted infection HPV
3- Can be passed on during sex between woman, although
chance is higher through heterosexual intercourse
4- Regular cervix screening prevents 75% of cervical cancer
from developing
Q: How often should lesbian have cervical screening ?

As often as heterosexual
Q:Cause of cervical cancer HPV which is passed on during sex
between male and females or between females can cause
changes in cervical cells

Q: where to go for screening?

GP practice by the practice nurse to look for HPV & abnormal

cells in the cervix

Q: How often should I do ?

3 yrs (25-49)

5yrs (50-64)
1- How long have you wanted to have this baby? (years)
2- Psychological state of the parent?
3- Financial state?? Where they are living (not homeless) ,
personal circumstances
4- R they in relationship?
5- R they deciding to have a baby alone?
6- If 2 relationship one will carry the baby sexual health
condition lesbian always ?? (toys), lesbian been straight
7- Medical conditions?
Conditions that run in family?
8- Council them and give them time?
9- Reason they want a baby (( my GF will end the
relationship if we don’t / forcing me to have a baby))
10- NAI????

Ways:
1- Donner insemination:
When male donates his sperms so a woman can
inseminate herself
a- Home
By using sperms of a friend or anonymus donner
b- Fertility clinic =liscenced clinic
Where sperms are screened free from STIS and certain
genetic disorders
*support legal advice
According to law lesbian couples who are in a civil
partnership at the time of conception and conceive a child
through donner insemination in a licensed clinic or private
arrangement at home both treated as child legal parents
**Couples who are not in a civil partnership but
conveived through donner insemination at licensed clinic

** Unlike 2 who are not in a cut partnership and conceice

through donner insemination by private arrangement at
home ((Non birth mother has no legal rights

2- Co-parenting:
2 or more people team up to conceive can be made
between ( 2 single, single+couple)

As a co-parent you won’t have sole custody

You must set legal advice on details about what role each
parent will take financial cast about degree and
involvement

3- Adoption or fostering:
You can apply through a local authority or adoptionor
fostering agency
4- Surogacy:
When a woman has (carry a baby) for couple who
can’t have a child
Surrogacy is legal in UK But it’s illegal to advertise for
surrogater or no financial benefits other than reasonable
Expenses can be paid to surrogate
The baby is not legally yours until parentral arder has
been issued after child birth this means surrogate can
have choosen to