Pre-Test Multi Choice Questions

1. Recommended HRT for trans women, include:

A

Estradiol valerate

B

Ethinylestradiol

C

Elleste Duet (estradiol + norethisterone)

D

Estradiol hemihydrate

E

A and C

F

A and D

2. At menopausal age, trans women:

A

could reduce their HRT dose to maintain serum estradiol approx. 200pmol/l

B

could reduce their HRT dose to maintain serum estradiol approx. 650pmol/l

C

should consider combination HRT

D

should aim to discontinue their HRT regime

3. Regarding gender diverse people accessing the National Breast Screening programme:

A

this is required by all

B

this is not usually required for people on testosterone therapy

C

this is not usually required for people who have undergone chest surgery

D

this is only required for those trans women with a significant genetic risk

E

none of the above

4. A person with a non-binary gender identity might affirm their gender through:

A

counselling

B

chest surgery only

C

anti-androgen only

D

low dose estradiol or testosterone

E

all of the above

F

A and D

5. GnRH agonist injection in trans women using estradiol can be associated with:

A

initial menopausal symptoms including hot flushes

B

transient reduction in bone density

C

thromboembolism

D

hypoactive sexual desire disorder

E

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:

A

Nebido is most commonly used

B

Sustanon has the highest rate of associated polycythaemia but could be considered as short-term starter therapy

C

Nicotine replacement therapy is contraindicated

D

testosterone gel applied daily can be associated with wide variation in mood

E

B and D

7. Polycythaemia associated with exogenous testosterone use:

A

is caused by testosterone inhibiting erythropoietin production

B

is compounded by smoking

C

is usually defined as haemoglobin >185 g/L and/or HCt >0.52

D

requires cessation of testosterone treatment until resolution

E

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

Spironolactone may have contributed to the thrombotic event

B

Finasteride reduces serum testosterone but has no impact on DHT (dihydrotestosterone)

C

topical estradiol is not associated with a significantly increased risk of DVT

D

all of the above

E

A, and C

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:

A

True

B

False

10. Pertaining to bilateral mastectomy with chest reconstruction surgery:

A

this is a gender affirming intervention available on the NHS exclusively to trans masculine people using testosterone therapy

B

smoking is associated with higher risk of free graft nipple loss

C

it is a requirement for a Gender Recognition Certificate under the Gender Recognition Act 2014

D

the peri-areolar technique is most commonly used

E

at least two years of testosterone therapy is a pre-requisite

F

none of the above

G

all of the above


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