Worked Case Examples; Question 1 - Vivian

Vivian is a 71-year old lady recently widowed following the death of her wife, Ellen. Having transitioned over two decades ago, she considers herself to be a ‘’woman with a trans history’’. She underwent genital surgery involving orchiectomy. Her children from her previous marriage broke contact when she transitioned, so she feels somewhat vulnerable despite being very active in the trans community and with the local church. 

She worries about life in a care home, particularly with regard to requiring help with personal care (including regular dilatation of her neo-vagina).

She is new to the surgery and comes to see you for a medication review, a little rattled that her HRT was not transferred onto her repeat prescription as this is something she wishes to continue indefinitely. She is fit and well apart from having well-controlled essential hypertension, and at present she takes Estradiol valerate 4mg daily, Amlodipine 10mg daily, Ramipril 2.5mg daily, and a Ca/Vitamin D supplement.

BP 142/84

BMI 28.1

Serum estradiol 540pmol/L

LFT, U/E, fasting lipids, fasting glucose and prolactin normal


In Vivian’s case, which of the following could be suggested regarding her HRT?


discontinuation of treatment having long passed menopausal age


a switch to patches or gel instead of oral treatment


a move onto a combination HRT


reducing her therapy to a ‘bone-maintenance’ dose


B, and D


C, and D




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