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Kai, aged 23 years, is a university student who has attended your clinic occasionally since the age of
20 years for combined oral contraceptive pill (COCP) scripts. Kai was assigned female at birth but has always felt uncomfortable living as female. They present today requesting testosterone treatment to affirm their gender identity. 1.What further information would you like to know about Kai’s gender? 2.What other medical, mental health and social history is particularly important when considering testosterone treatment? 3.What are your options for initiating hormone treatment for gender affirmation in terms of initiating hormones yourself or referral? 4.What would be your next steps at the second consultation with Kai to prepare for hormone treatment? 5.What information is important for Kai to know about testosterone before you give the prescription? 6.What is the ideal monitoring and review process for testosterone therapy? 7.How would you respond if Kai preferred a low dose of testosterone? Are there any clinical concerns in using a ‘low- dose’ hormone regimen for trans patients? 8.When would you stop Kai’s COCP? 9.What are the possible causes of Kai’s dyspareunia, and how would you investigate it? 10.How would you manage secondary polycythaemia in this situation? #Week16_Case4
Peta, a transgender woman aged 27 years from the inner-city suburbs, presents with pain and discharge ‘downstairs’ for the past three weeks. She has not sought help for this before now because her last doctor was rude and insisted on calling her ‘he’. 1.How can you help Peta feel more comfortable in this consultation? 2.What further information is important on history? 3.What is the most likely cause of her symptoms? 4.What tests will you order? 5.What treatment will you offer Peta? 6.What are your next steps? What is your advice for Peta regarding her sexual partners? 7.What are your next steps? #Week16_Case3
https://www.healthymale.org.au/files/inline-files/9_Erectile%20Dysfunction_CSG_Healthy%20Male%202022.pdf #Sexual_Health_Inventory_For_Men
Kumar, aged 37 years, is a cisgender heterosexual male who comes to see you alone for the first time for erectile difficulties and fertility issues. He is a well- educated information technology professional of Indian origin who migrated to Australia eight years ago. Kumar has been married to his wife, aged 34 years, for seven years and they have a daughter, aged six years. He has no known diagnosis, is a non-smoker and is not taking any regular medication. He has a sedentary lifestyle with very minimal physical activity. Kumar and his wife have been trying for a second child for the past year with no success. He is concerned about his sperm parameters and erectile dysfunction, for which he has tried sildenafil unsuccessfully. 1.What further history is important when assessing erectile (dys)function?
2.What aspects of sexual history are critical in this case? 3.What ethical dilemmas might you have in treating Kumar? 4.What clinical dilemmas might you have in treating Kumar? 5.What investigations and assessments would you consider? 6.Would you have a definitive diagnose at this stage? If yes, what? If not, what is your approach? 7.As a general practitioner (GP), what are the initial steps in the management of this case? 8.What is sex therapy? How can GPs work collaboratively with sex therapists? #Week16_Case2
