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Gynecologic Care for Transgender Patients

Introduction: Role of the Gynecologist Obstetricians, gynecologists (OBGYNs), and other women’s health providers have a critical role in the care of transgender people. Transgender people, both transgender men and transgender women, have biophysiological and sociocultural needs, which can be addressed by the comprehensive and caring attention of the OBGYN provider. For transgender men, the need for OBGYN care fits perfectly within an OBGYN’s scope of practice;…

Primary and Preventative Care for Transgender Patients

Introduction Primary care clinicians can learn the skills to provide high-quality, affirming medical care to transgender patients the same way they learn to care for other patients with specific health needs. Clinicians may choose to provide the full spectrum of transition-related medical care, including hormonal therapy and pubertal blockers, or offer only primary care services. Regardless of scope, competency in care for transgender people is essential…

Genital Gender Confirmation Surgery for Patients Assigned Female at Birth

Acknowledgments This chapter is supported by Ministry of Science and Technical Development, Republic of Serbia, Project No. 175048. Introduction Patients suffering from gender dysphoria feel that their gender assigned at birth is in some way “wrong” and therefore seek to take the opposite gender role. Gender dysphoria is a state that requires a multidisciplinary approach to treatment, and the only real management consists of “adjusting the…

Genital Gender Confirmation Surgery for Patients Assigned Male at Birth

Introduction Gender confirmation surgery (GCS) for the male-to-female (MTF) individual fulfills a final, completive step in a process that, for most, has spanned years or decades. Completing this surgical journey is rate-limited historically by cost, by fears of complications, and by uncertainty over the final outcome. When the need to find anatomical wholeness overcomes these reservations, genital reassignment is chosen. Broadening of insurance coverage, reduction in…

Breast and Chest Surgery for Transgender Patients

Introduction Breast or chest surgery, specifically either augmentation mammaplasty or mastectomy/chest reconstruction, are commonly requested procedures in the transgender and gender diverse population. The overarching goal of such surgeries is to alleviate symptoms of gender dysphoria and to allow individuals to live as their true selves. Individual goals vary between patients. In some individuals, breast or chest surgery is the only desired procedure, while in others,…

Facial Feminization Surgery and Facial Gender Confirmation Surgery

Acknowledgments To our team, our families, and our patients. Introduction From a very early age, everyone is able to recognize whether a face is male or female, long before learning about genital differences. The perception of gender through facial features occurs in a single glance, involuntarily, and definitively. While other parts of the body can be hidden, camouflaged, or exaggerated to appear more feminine, it is…

Overview of Surgery for Transgender Patients

Introduction Gender affirmation surgery (formerly called sex reassignment surgery) may be sought by transgender individuals to physically change their sexual characteristics to affirm their gender identity. While not all transgender individuals choose to undergo gender affirmation surgery, surgical treatment is a medically necessary, standard-of-care intervention for gender dysphoria for many transgender patients. Gender affirmation surgery helps transgender patients transition both physically and socially, and helps alleviate…

Hormone Treatment for the Adolescent Transgender Patient

Foreword While it is still a different era than anyone born before 1965 can remember, much is left to be done to optimize care of transgender youth. Whether to include Gender Dysphoria as a psychiatric diagnosis in the next version of the Diagnostic and Statistical Manual of Psychiatric Diseases (DSM) remains controversial. This is reminiscent of 1973, when homosexuality was removed from the DSM as a…

Hormone Treatment for the Adult Transgender Patient

Introduction Transgender medicine is a developing field of medicine that spans multiple subspecialties. Transgender individuals are defined as those whose gender identity differs from the assigned sex recorded for them at birth based on external sexual characteristics. Gender identity includes an innate biologic component in humans, rather than a reversible trait developed from societal constructs. This chapter will provide an overview of the different modalities of…

Disorders of Sexual Development

Introduction Disorders of sexual development (DSD)―a less derogatory term than intersex―are a heterogenous group of conditions characterized by aberrant chromosomal, gonadal, and/or anatomic sex with widely varying genotypic and phenotypic manifestations. Sexual differentiation comprises three successive steps: (1) genotypic events determined at conception in regard to chromosomal composition; (2) phenotypic events driven from the chromosomal makeup, which induce gonadal differentiation; and (3) gender identity formation, which…

Mental Health Care for the Child and Adolescent Transgender Patient

Introduction The Lesbian, Gay, Bisexual, and Transgender (LGBT) community has built tremendous momentum in raising awareness of its presence in our communities, and in the past several decades we have seen the positive impacts that LGBT and ally groups have made on society. However, despite these great strides, the community is still significantly marred by stigma, hate, and isolation and is often susceptible to the immense…

Mental Health Care for the Adult Transgender Patient

Introduction Transgender identity is not a mental illness; however, mental health assessment and care is an integral part of transgender care. Transgender people may present with gender dysphoria, for help in exploring their gender identity, or for mental health conditions like depression, anxiety, or substance abuse that may be related to societal prejudice and trauma, which are commonly experienced by trans people. Misunderstanding or failure to…

An Introduction to Gender Diversity

Introduction Transsexual, transgender, and gender nonconforming individuals have been a part of all cultures historically, yet the emergence of, and advocacy for, transgender individuals in the Western world have become prominent only in recent decades. The majority of clinical experience related to transgender care is derived from higher-income settings. Therefore local adaptation of clinical care protocols is required, in view of varying cultures and social norms…

Challenges in predicting the pharmacokinetics of drugs in premature and mature newborns: example with piperacillin and tazobactam

24.1 Introduction Using pharmacokinetic models to predict drug plasma time courses after drug or chemical administration to newborns is an active field of research and application [ ]. Physiologically based pharmacokinetic (PBPK) modeling is one of the more sophisticated computational tools. This type of mathematical modeling has its foundational methodology based on physiology and biochemistry, which is important when considering maternal physiology changes that occur during…

Gastrointestinal disorders

23.1 Gastroesophageal reflux disease Gastroesophageal reflux disease (GERD), most commonly manifested as heartburn, is estimated to affect 40%–85% of pregnant women [ ]. Risk factors for GERD in pregnancy include increasing gestational age, parity, and a history of heartburn [ ]. In addition to heartburn, pregnant women may experience other GERD-related symptoms such as regurgitation and epigastric pain. Less likely manifestations of GERD include chest pain,…

Envenomations and antivenom during pregnancy

22.1 General principles about envenomation Envenomation is the exposure to a poison or toxin resulting from a bite or sting from an animal. The medically important venomous animals consist of several major categories: snakes, spiders, scorpions, hymenoptera (bees, wasps, and ants), and marine animals (some fish and cnidarians, such as jellyfish, anemones, and corals). Information about a bite or sting is often obtained secondhand from patients…

Herbs and alternative remedies

Pregnancy can be an ideal time to use herbal and alternative remedies. Herbs are often mild preparations of natural compounds that can be just perfect for some of the discomforts and illnesses during pregnancy. Several studies have shown that as many as 50% or more of women will choose herbs and alternative remedies as therapies during pregnancy [ ]. Although herbal therapies have been used for…

Management of dermatological conditions in pregnancy

20.1 Introduction Every system in the body undergoes drastic changes during pregnancy, including the integumentary system. These dermatological changes are a result of varying factors, such as alterations in collagen formation, increase in sebaceous and eccrine gland secretion, shifts in hormone production, and increased circulatory blood volume [ ]. This can lead to the development of new or worsening of current dermatological conditions during pregnancy. While…

Antenatal thyroid disease and pharmacotherapy in pregnancy

19.1 Thyroid function and physiology in pregnancy In pregnancy, abnormalities of the thyroid gland can be easily overlooked due to the normal physiologic changes of pregnancy often mimicking disturbances of thyroid gland function. As a result, basic knowledge of thyroid gland function and the changes the thyroid gland undergoes during the course of pregnancy are essential. Regulation of the thyroid gland and its hormones is controlled…

Uterotonics and tocolytics

18.1 Introduction The uterus has two major components: the cervix and the corpus. The uterine cervix comprises the external os, the internal os, and the cervical canal that connects them. The corpus comprises the uterine fundus and the main uterine body. Anatomically, there are four layers of the uterus. The outermost layer, the perimetrium, is serosal in nature and is analogous to the peritoneum. Beneath the…