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Case 4: Transgender Women and HIV

You answered:

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.

This answer is incorrect. Although some potential drug interactions do exist with antiretroviral medications and estrogen compounds, a safe antiretroviral regimen can be constructed for transgender patients receiving hormonal reassignment therapy. In addition, providing hormonal therapy may provide an incentive for HIV-infected transgender women to regularly attend medical clinic visits and engage in care for their HIV disease.

Choose another answer:

A Doses of estrogens required for gender reassignment hormonal therapy are typically much lower than doses used for hormone replacement therapy in postmenopausal women.
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.
C Anti-androgen therapy with spironolactone (Aldactone) is often used as part of hormonal gender reassignment therapy to further decrease male secondary sexual characteristics.

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