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Case 4: Transgender Women and HIV

You answered:

B Considering this woman’s age, oral ethinyl estradiol (Estinyl) would be preferred over a transdermal estradiol patch. The oral estrogen treatment would have a significantly lower risk of causing thromboembolic complications than a transdermal estradiol patch.

This answer is incorrect. In general, transdermal preparations of estrogen are considered to have a lower risk of thromboembolic complications than oral estrogens. Multiple studies have shown that smokers and patients older than 40 have an increased risk of developing thromboembolic complications while taking estrogen therapy. Thus, in this patient, who is over 40, transdermal estrogen would be preferred over oral estrogen therapy. In addition, injectable estrogen also has a low risk for causing thromboembolic complications and is an excellent alternative to transdermal estrogen in situations of high baseline risk for thromboembolism.

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A Doses of estrogens required for gender reassignment hormonal therapy are typically much lower than doses used for hormone replacement therapy in postmenopausal women.
C Anti-androgen therapy with spironolactone (Aldactone) is often used as part of hormonal gender reassignment therapy to further decrease male secondary sexual characteristics.
D No hormonal therapy should be given. The patient needs antiretroviral therapy and the co-administration of antiretroviral therapy and gender reassignment hormonal therapy is contraindicated.