"transgender" AND "physiology" AND "gender affirming hormone therapy"

"gender affirming hormone therapy" AND "cardiovascular" OR "bone" OR "mental health"

"transgender" AND "neuroendocrinology" OR "HPA axis" OR "hypothalamic pituitary"

Handwritten medical notes style, neat cursive/print handwriting on white ruled paper with blue ink. Title at top: "PHYSIOLOGICAL ISSUES IN TRANSGENDER, GENDER NON-CONFORMING & NON-BINARY INDIVIDUALS" underlined twice. Content: DEFINITION BOX: • Transgender: gender identity ≠ assigned sex at birth • Non-binary: gender identity outside male/female binary • Gender non-conforming: does not conform to societal gender norms • Gender Dysphoria (DSM-5): distress from incongruence between gender identity and assigned sex CLASSIFICATION of PHYSIOLOGICAL ISSUES: 1. Neuroendocrine & HPG Axis Issues 2. Cardiovascular System 3. Musculoskeletal System (Bone & Muscle) 4. Reproductive Physiology 5. Mental Health & Stress Axis (HPA) 6. Metabolic Issues 7. Effects of Gender-Affirming Hormone Therapy (GAHT)

Handwritten medical notes on white lined paper, blue ink, neat student handwriting for MD Physiology exam. Title: "1. NEUROENDOCRINE & HPG AXIS PHYSIOLOGY" (underlined) Content written by hand: HPG Axis Overview: Hypothalamus → GnRH (pulsatile) → Anterior Pituitary → LH + FSH → Gonads → Sex steroids (Estrogen/Testosterone) → Feedback inhibition Key Physiological Points: • GnRH neurons arise from olfactory placode, migrate to medial preoptic area • Kisspeptin (via GPR54) governs GnRH secretion — sexually dimorphic • In transgender individuals: endogenous HPG axis produces sex steroids mismatched with gender identity • GnRH analogues (puberty blockers) used in adolescents: pause endogenous puberty • Suppression → ↓ LH, FSH → ↓ gonadal sex steroid production • Negative feedback disrupted when cross-sex hormones administered Sex Differences in HPG Axis: Female: cyclic LH/FSH secretion → follicular phase, ovulation, luteal phase Male: tonic LH secretion → continuous testosterone synthesis Transgender: exogenous hormones impose cross-sex hormonal milieu on biological tissues

Handwritten medical exam notes on white ruled paper, blue pen, neat handwriting. Title: "2. CARDIOVASCULAR PHYSIOLOGICAL ISSUES" (underlined) A. Trans Women (Male → Female, estrogen therapy): • ↑ Estrogen → ↑ coagulation factors (II, VII, VIII, X) → ↑ VTE risk (DVT/PE) • ↑ Triglycerides, ↓ LDL, ↑ HDL (favorable lipid profile) • ↑ Prolactin levels • Blood pressure: variable — estrogen generally vasodilatory • ↑ Risk of ischemic stroke (especially with synthetic progestogens) • Polycythemia less common (unlike trans men) B. Trans Men (Female → Male, testosterone therapy): • ↑ Testosterone → ↑ RBC mass → ↑ Hematocrit → ↑ blood viscosity → ↑ thrombotic risk • ↑ LDL, ↓ HDL (unfavorable lipid shift) • ↑ Systolic blood pressure • ↑ Left ventricular mass (hypertrophic response) • Erythropoiesis stimulated via EPO pathway in kidneys • ↑ Cardiovascular risk with long-term testosterone Mnemonic: "T for Trans Men = Testosterone = Thick blood + Tricky lipids"