The ACOG Committee Opinion: Treating the Transgender Individual
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Identify the steps in initiating puberty suppression in transgender adolescents 2. List the health risks of testosterone use in transgender males
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 12/31/2017 through 1/25/2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Prior to initiating gender-affirming treatment, the diagnosis of gender dysphoria should be made by a mental health professional skilled in the area. Individuals must be capable of understanding both benefits and risks of treatments as well as implications for future fertility. If a decision is made to proceed, the following is recommended
Role change and hormone treatment should be deferred until puberty
Puberty suppression with GnRH agonists should be initiated when girls and boys begin puberty but no earlier than Tanner Stage 2
Pubertal development of the opposite sex should be initiated around age 16 using the following hormonal medications
Transgender males: Testosterone
Transgender females: Estrogen and androgen blockers (e.g., spironolactone)
Definitive surgery for gender affirmation should be deferred until at least age 18
Clinical and laboratory monitoring every 3 months for the first year, then annually or biannually
Care of the transgender patient requires a safe and sensitive clinical environment, including gender-neutral forms, brochures and information for sexual minorities, and use of open-ended questions about a patient’s gender identity, sexual orientation, transition and therapy. Use of estrogen in the transgender female increases risk of thromboembolism, macroprolactinoma, liver dysfunction, breast cancer, coronary artery and cerebrovascular disease. Use of testosterone in the transgender male increases risk of breast/uterine cancer, erythrocytosis and liver dysfunction.
Adolescents may need parental consent for treatment even in states that allow emancipated minor status for behavioral health, STI treatment and contraception
Once initiated, cross-sex hormone levels should be maintained in the physiologic range of the appropriate gender
Monitor prolactin levels in transgender females on estrogen
Evaluate all patients for cardiovascular risk factors
Measure bone mineral density (BMD) if risk factors for osteoporosis exist
Transgender females should follow screening guidelines for breast cancer detection, as well as guidelines for prostate disease and prostate cancer
Transgender males should consider risks and benefits of total abdominal hysterectomy and bilateral salpingo-oophorectomy as part of sex reassignment surgery
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan