Basics of Gender Affirming Healthcare for Trans and Gender Diverse Patients

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Hi jill,
I'm sorry they i user to leave the class. I found your insight interesting and will listen to recording. I got completely thrown off my day . An emergency came up. Thank you for your offerings! Have a great weekend

Hi Dr. Corey, thanks for sharing all of your expertise! I have some comments and a question. I had understood that pregnancies in transmasc people after discontinuing T were generally thought to be as successful as in cisgender women. There’s a Boston IVF study about it, but ofc this is in the context of IVF only. Your presentation makes clear that fertility after T is not so assured, so that was helpful.

I have also read that if AMAB patients undergo hormonal transition too early, it can affect their post-pubescent ability to orgasm. Do you know more about this? Is that if hormone blockers are started earlier than Tanner stage 2?

Something I’ve run into in my practice is a transmasc patient’s concern about herbal therapies reversing their transition, in this case a top surgery. They ultimately found the herbal medicine to be helpful with vertigo and other post-op symptoms. In this case I felt quite confident about not reversing anything, but there are are other times with patients that menstruate that I realize our medicine may make unwanted changes. I know Chinese herbal medicine is outside of Dr. Corey’s wheelhouse, but I wanted to share it here to start a larger conversation. The way I’ve dealt with this so far is to explain something along the lines of “part of your diagnosis is blood stasis. When we address this, there may be changes to your menstrual cycle that could look like xyz. How do you feel about that?” So far, in my fairly limited experience, everyone has been open to those potential changes, but have been able to choose whether or not to continue. Curious to hear if others have been surprised about effects herbs did or didn’t have on a trans patient’s hormone therapy.

Hello! Thank you for your questions.
1. Yes, if any person is going on GAHT we have to make sure they are aware that it can impact fertility. This risk increases the longer they are on GAHT. While infertility does not happen to all pts on GAHT it can happen and pts must be aware before starting bc the prescriber will be liable for not informing the patent of the fertility risks.

2.. I have not seen this among my patients but it can happen. All of my patients I have seen so far that have done puberty blockers and GAHT have this ability. Furthermore, a provider should not be giving hormones "too early" this is usually done during the age ranges of 14-15 yo. A provider intining GAHT before 13 yo would be considered "too early". I have never done this or seen another provider prescribe hormones before 13yo. So unfortunately, I can't speak to the inability to orgasm with giving GAHT before 13 yo but given the proper age range (14-15 yo).

-More thoughts on this: so puberty blockers and GAHT combination CAN impact ability to orgasm if given at the proper ages (14-15 yo). In my experience, I haven't seen it but it is a risk. This is an additional thing to make the patient and the family aware of before initiating medical transition. However, a lot of patients will consider this a minor inconvenience compared to the agony of going through the wrong puberty but we must still provide them with this information before going thru medical transition so they can make informed consent. Additionally, transfeminine patients who decide to have estradiol therapy in adulthood, estradiol can impact their ability to have an erection and or/an orgasm and this is always discussed with the patient before initiating GAHT.

3. I have not run in to this much my practice. However, I am not trained in TCM herbs but for my trans masc pts they'd usually like to avoid phytoestrogen type herbs to prevent gynecomastia. I also tell them if they are concerned to avoid IPAs and marijuana.

Hopefully this provides clarification...

Jill Corey ND

Thank you! I really appreciate you for sharing your clinical knowledge.