Read this discussion and agree or disagree with their chosen plan. Support your

Read this discussion and agree or disagree with their chosen plan. Support your postings with evidence based practice. APA format with 1 reference cited not older than 5 years easily retrievable. 250 words minimum. Spironolactone is used in Transgender populations for its effects on androgen receptors and suppressive effect on Testosterone synthesis. (Deutsch, 2016) Spironolactone is a potassium sparing diuretic as well, which would alert the clinician that hyperkalemia would be a concern. When ordering labs for Martha, I would be sure to order a comprehensive metabolic panel to monitor her electrolytes and hydration status since it does have diuretic effects. I would also order hormone levels to assess how she is responding to her current dose of Estrogen. I would order labs for every three months to start with since she is just establishing, although she has been on treatment for over one year as a precaution. Estrogen can cause an increased risk of clots especially if you smoke or are over the age of 35, so monitoring a d-dimer level could be beneficial to assess for clots. In a study done by Deutsch et al., it was found that transgender women on Estrogen therapy had a decrease in blood pressure; so, it is important to also monitor Martha’s blood pressure at each visit and outpatient. Estrogen can also effect lipids so I would order a lipid panel to understand Martha’s baseline and check those again in three months when we rechecked labs. The greatest concern among male-to-female (MTF) transgender individuals is the potential increase in thromboembolic events associated with estrogen therapy. (Weinand & Safer, 2015) Due to this concern, it would be contraindicated for a patient to take Estrogen that has a personal history of a DVT, PE, VTE, or Ischemic Stroke and should be used with caution in patients who smoke. In a study conducted by Weinand & Safer, three transgender women experienced a myocardial infarction (average 48 years old) within two years of estrogen therapy. Due to this finding, patients with existing cardiac conditions (specifically MI’s) should proceed with caution when using Estrogen therapy. Patients with a strong family history of breast cancer should also proceed with caution when taking Estrogen therapy, as this could increase their risk of breast cancer as well. To minimize these risks, patients could undergo genetic testing if they choose to proceed with Estrogen administration. Another patient population that would be a contraindication for Estrogen therapy is a patient who has a history of liver disease, is a heavy drinker, or has a family history of liver disease. Oral Estrogen can affect the liver and these patients may benefit from transdermal or injectable Estrogen. As with anything, the benefits must outweigh the risk for our patient who is undergoing treatment. To us, we may think that these risks are not worth taking Estrogen; but to our patients who have struggled with gender identity and wish to undergo transition, the benefits may vastly outweigh these risks. As providers, we must remember to equip our patients to make the best choice for them and their current situation. If these at-risk populations chose to move forward, we would need to bring them in for screenings more frequently and educate them on warning signs and symptoms for development of these serious conditions.