36 yo biological male, identifies as female, diagnosed with gender dysphoria in 2019 by therapist. The patient seen by endocrinology in 2019 and started on estradiol, spironolactone, bicalutamine and has been on same regimen since. Is tolerating med well. The patient is currently incarcerated in a male correctional facility and is established with mental health team and states this is going well. She is generally content with the current POC, although would like to have increased bra size. Recent lab: CMP, CBC, lipids wnl. Estradiol E2 251 pg/ml, estrogen total 1769 pg/ml. estrone 1518. Total testosterone 10 ng/dl, free testosterone 0.64 pg/nl, sex hormone binding glob 131
- Is continuing the current medication regimen recommended?
- Are there other recommendations for safety/monitoring?
- The patient would like eventual surgery and bigger bra size but appears to be generally content with current plan of care and facility support. No mental health concerns are voiced by patient. When is a change of plan of care indicated?
Thank you very much for your thoughts.