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1. Objectives

• Understand terminology related to transitioning
   
• Review DSM and WPATH criteria for Gender Dysphoria
   
• Learn about pronouns and respectful communication
   
• Discuss legal name changes, surgeries, and medications
   
• Overview of possible surgeries and trauma assessment items
   

3. Transition Types

• Social: Coming out to friends, family, co-workers
   
• Medical: Hormones, gender-affirming surgeries
   
• Legal: Name changes, updating government documents1
   

4. Medical and Surgical Procedures

For AFAB (Assigned Female at Birth) Patients

• Medications: Testosterone (effects include voice deepening, increased body hair, cessation of menses, changes in fat distribution, increased RBC, etc.)
   
• Top Surgeries: Double incision, buttonhole, inverted-T, peri-areolar, keyhole, minimal scarring
   
• Bottom Surgeries: Hysterectomy, phalloplasty (free flap, pedicled flap, radial forearm, abdominal, MLD, ALT flap), metoidioplasty (simple, ring)1
   

For AMAB (Assigned Male at Birth) Patients

• Medications: Estrogen (effects include fat redistribution, reduced muscle, breast development, skin changes), Finasteride, Spironolactone
   
• Surgeries: Vaginoplasty (penile inversion, rectosigmoid, peritoneal pull-through), vulvoplasty, orchiectomy1
   

5. Risks and Complications

• Surgical risks: Scarring, tissue granulation, decreased sensation, wound breakdown, infection, necrosis, fistulas, urethral complications
   
• Medication risks: Hyperkalemia (spironolactone), cardiovascular risks (estrogen, testosterone), orthostatic hypotension (finasteride)1
   

6. Patient Care Best Practices

• Always use the patient’s chosen name and pronouns
   
• If misgendering occurs, correct and move on respectfully
   
• For charting, use legal name/gender if no legal change, but note preferred name/pronouns in the narrative
   
• Not all transgender people pursue surgery or hormones
   
• For medical procedures (e.g., 12-lead ECG), use sex assigned at birth if algorithm is gender-specific1
   

7. Professional Guidelines

• WPATH: Promotes evidence-based care, education, and advocacy for transgender health worldwide1