LGBTQI
LESBIAN
GAY
BISEXUAL
TRANSGENDER
QUEER
QUESTIONING
INTERSEX
HEALTH DISPARITY
STRUCTURAL INEQUALITIES AND HEALTH INEQUITIES ARE RELATED
DIFFERENT LAWS STATE TO STATE
HEALTHY PEOPLE 2020-LGBTQ OBJECTIVES
LGBTQ HEALTH DISPARITIES
smoke more
higher drug and alcohol rates
2-3 x more likely to atempt suicide
20-40% of homeless youths are lgbtq
higher risk off HIV and STI
lesbians less likely cancer prevention
transgender people very high suicide attempt rates
lgbtq health risks
> mort and morbidity
>financial and economic insecurity
> risky coping behaviors, lack of support systems - family social
lqbtq barrier s
disclosure- fear of stigma
poor education of providers
financial -ins coverage for meds, sex reassignment ,mentl health treatment-TESTING FEMALE COVERAGE FOR PSA
structural- bathrooms,billing/codiing
lqbtg
communication
get to know person-partner, jobs children , living circ
use inclusive language-partner vs wife/husband
use a patients preferred pronouns
trans women-she her
trans men-he his
if unsrure of pronoun,ask-use wrong pronoun? apologize
testing-trans
trans males may need mammogram
trans females may need psa
estrogen > cardiac risk factors
what is gender identity
a persons internal sense of their gender- female,male both
GENDER EXPRESSION
HOW ONE EXPRESSES THEMSELVES-SPEECH DRESS MANNERISMS
LGBQ
PRIMARY CARE
SCREEN FOR MENTAL HEALTH DISORDERS
SUBSTANCE USE/ABUSE
IPV-INTIMATE PTNER VIOLENCE
IMMUNIZATIONS
HORMONE THERAPY INITIATE OR MAINTAIN
STIS
CANCER
LABS BASED ON ABOVE
CA SCREENINGS?
“SCREEN WHAT YOU HAVE”
LGBTQ
GENDER IDENTITY AND SEXUAL ORIENTATION
SOGI
ARE NOT EQUAL
NEED ORGAN INVENTORY
HORMONE THERAPY
BENEFITS OUTWEIGH RISKS
CARDIAC RISK CALCULATORS : MALE OR FEMALE
DEPENDS ON HOW LONG THEY HAVE BEEN ON HORMONE THERAPY,
10-20 YEARS MAY GOEITHER WAY
ALLOSTATIC LOAD - PHYSIOLOGIC STRESS - ADRENAL CORTISOL PRODUCTION, ADRENERGIC , AFFECTS PITUITARY ADRENAL AXIS’
DIRECTLY LINKED TO CV RISK, ENDOTHELIAL DAMAGE
IS RISK FACTOR FROM BEING TRANSGENDER/LGBTQI OR HORMONES
HORMONE THERAPY AND THROMBO EMBOLIC RISK
INCREASE IN RISK COMPARED TO MEN AND WOMEN HIGHER STROKE , MI , VTE I THINK
TAKE HOME IS : I DONT KNOW
DM AND HORMONE THERAPY: 6 YEAR TIME WINDOW, NO STAT SIGNIFICANCE
VTE
INCREASE IN HORMONE THERAPY
ETHINYL ESTRADIOL NO LONGER BEING USEDAS MUCH,
ITS THROMBOGENIC
17 BETA ESTRADIOL-BIOIDENTICAL MIXED NO RISK THIS IS NEWER THERAPY
LOWER THROMBOGENIC TO NORISK IF USE TRANSDERMAL ESTRADIOL
ORAL ESTRADIOL- AS MUCH AS 4 FOLD RISK
WHY ORAL HIGHER - FIRST PASS METABOLISM THROUGH LIVER, TIPS SCALES OF CLOTTING FACTORS PRODUCTION -HIGHER
tRANSGENDER 7.5 X MORE ESTROGEN THAN CONTRACEPTIVE PILL
IN GENERAL BLOOD CLOTS NOT BIG RISK ESP TRANSDERMAL
DO NOT ANTICOAGULATE OR ANTIPLATELET SOMEONE BASED ON ESTROGEN THERAPY
TRANSGENDER HORMONES PERIOPERATIVE CONSIDERATIONS
CAPRINI SCORING LOOK AT FACTORS
ACOG RECOMMENDS AGAINST STOPPING HORMONES OR OCP FOR SURGERY
HAVE TO DO IT 4-6 WEEKS IN ADVANCE
HORMONE REPLACEMENT THERAPY
Sx MASTECTOMY
NOT WELL STUDIED LCK OF DATA
LOWER RATES BREAST CA THAN CIS WOMEN
HIGHER RATES THAN CIS MEN
UCSF GUIDELINES
ENDOCRINE SOCIETY -INITIATING HORMONE THERAPY
FENWAY HEALTH - PT EDUCATION
AGE TO INITIATE TREATMENT
WPAS STANDARDS OF CARE, PUBERTY TEN OR STAGE 2? WHAT THE FUCK
NOT BEFORE AGE 14
CHEST SURGERY CAN BE EARLY AS 15 OR 16
SX FOR TRANSGENDER WOMEN PROSTATE NOT REMOVED DUE TO SEXUAL IMPOTENCE OR URINARY INCONTINENCE, SCREENING IS COMPLEX, PSA
Last changed7 months ago