Caring for transgender patients with epilepsy

Johnson, Emily L.; Kaplan, Peter W.

doi:10.1111/epi.13864

Cited by 24 publications

(20 citation statements)

References 46 publications

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“…Carbamazepine and oxcarbazepine, first‐line agents for trigeminal neuralgia, can significantly reduce estrogen levels and should be avoided 57 . In the case of testosterone, although topiramate may not significantly affect testosterone levels, carbamazepine, oxcarbazepine, and zonisamide may reduce levels 57 . Conversely, valproate may increase testosterone levels 57 …”

Section: Drug–drug Interactions In Transgender Headache Carementioning

confidence: 99%

“…Many ARTs can have complex drug–drug interactions, especially protease inhibitors that are CYP 3A4 inhibitors. Due to bidirectional interactions, carbamazepine and oxcarbazepine for trigeminal neuralgia should be avoided 57,60,61 57 .…”

Section: Drug–drug Interactions In Transgender Headache Carementioning

confidence: 99%

“…56 Topiramate also increases serum levels of sex hormone-binding globulin, leading to lower levels of free estrogen and progesterone. 57 Prior pharmacokinetic studies of the effects of topiramate on oral contraceptives containing ethinyl estradiol have shown decreased estrogen levels by 5.5% and 12% with topiramate doses of 200 mg or less per day. 58,59 If considered, avoid using doses more than 200 mg and consider coordinating with the GAHT prescriber to monitor estrogen levels after starting topiramate.…”

Section: Drug-drug Inter Ac Tions In Tr Ansg Ender He Adache C Arementioning

confidence: 99%

“…57 In the case of testosterone, although topiramate may not significantly affect testosterone levels, carbamazepine, oxcarbazepine, and zonisamide may reduce levels. 57 Conversely, valproate may increase testosterone levels. 57 Gabapentin is not an enzyme inducer (or inhibitor), so it should not interact with GAHT.…”

Section: Drug-drug Inter Ac Tions In Tr Ansg Ender He Adache C Arementioning

confidence: 99%

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Headache in transgender and gender‐diverse patients: A narrative review

et al. 2021

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Objective: To summarize the unique aspects of managing headache in gender minorities and current research in this area including the potential relationship between gender-affirming hormone therapy (GAHT) and headache. Background:The study of headache in gender minorities is intrinsically important.Gender minorities are medically underserved, and their medical care to date has been limited by socioeconomic disadvantages including stigma and an unsupportive clinical environment. Despite the rising population of transgender and gender-diverse adults and youth, headache research has also been limited. Knowledge of hormonal effects on headache in cisgender patients raises the question of possible effects of GAHT on transgender patients. Methods/Results:The manuscript is a narrative review of current best practices in treating transgender patients, including the use of appropriate terminology and ways to create a supportive environment. It also contains current guidelines on GAHT and reviews drug-drug interactions and secondary headache related to hormone therapy.We also review transgender headache research and related research on hormonal effects on headache in cisgender individuals. Conclusion:Creating a supportive environment for transgender and gender-diverse patients and being knowledgeable about GAHT are key to providing quality headache care. This review identifies further research needs for this population including the epidemiology of headache disorders in sexual minorities and the potential effects of GAHT on headache disorders in transgender patients.

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Section: Drug–drug Interactions In Transgender Headache Carementioning

confidence: 99%

Section: Drug–drug Interactions In Transgender Headache Carementioning

confidence: 99%

Section: Drug-drug Inter Ac Tions In Tr Ansg Ender He Adache C Arementioning

confidence: 99%

Section: Drug-drug Inter Ac Tions In Tr Ansg Ender He Adache C Arementioning

confidence: 99%

See 2 more Smart Citations

Headache in transgender and gender‐diverse patients: A narrative review

et al. 2021

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“…23,91,92 These complex drug–drug interactions in TG persons can be further complicated when other comorbid diseases (e.g., epilepsy) are also present and HIV medications, antiepileptics, and hormones are coprescribed. 93 While low doses of ethinyl estradiol alone or combined with progestins in contraceptive pills have a number of interactions with antiretroviral therapy, primarily non-nucleos(t)ide reverse transcriptase inhibitors and protease inhibitors boosted with ritonavir, 91,94 the extent of these drug–drug interactions with higher estradiol doses typically used in hormone therapy in TG individuals remains unclear. Nevertheless, the perception among many HIV-infected TG women is that antiretroviral therapy may impact the feminizing effects of estrogen therapy.…”

Section: Tg Individuals and Stdsmentioning

confidence: 99%

The Evolving Role of Pharmacists in Transgender Health Care

Redfern

Jann

2019

Transgender Health

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Pharmacists are increasingly part of a multifaceted team providing health care to members of the often marginalized transgender (TG) community. Some pharmacists, however, may feel unprepared to care for and interact with TG individuals. By providing comprehensive, respectful, and gender-affirming support, improving physical pharmacy environments with policies and procedures, pharmacists can be trustworthy providers for TG patients. This review focuses primarily on the health issues of TG persons and the pharmacist's role in promoting health, identifying barriers to health care, and providing health care resources for TG persons. The evolution of psychiatric diagnostic criteria, access to health care, and inclusion of TG, lesbian, gay, and bisexual topics in the educational curriculum are presented. Cultural competency and diversity training that addresses gender identity and sexual orientation issues should be important interdisciplinary and interprofessional activities for all health care professional education programs. Pharmacists play a key role in the health care needs of TG persons that include appropriate laboratory monitoring, complex pharmacotherapeutic challenges, and providing unbiased gender-affirming interactions. The pharmacy's physical environment, staff training, and policies and procedures can offer unique services to TG persons.

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Acute Clinical Care for Transgender Patients

et al. 2018

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IMPORTANCETransgender is an umbrella term used to describe individuals whose gender identity and/or gender expression differs from assigned sex at birth. There are an estimated 1.4 million transgender adults in the United States, and this number is increasing. Clinicians will increasingly be caring for transgender patients. Topics considered in this narrative review include terminology, how to address transgender patients, obtaining an inclusive history that takes into account gender-affirming surgery, managing hormone therapy and other clinical issues, consideration for hospitalized patients, interpreting laboratory values in the setting of hormone use, legal issues, and considerations for health systems.OBSERVATIONS Best practices in caring for a transgender patient include using a patient-identified name and pronoun, using gender-neutral terminology until the appropriate term is identified by the patient, and obtaining a surgical history inclusive of an anatomic inventory. Gender-affirming hormones can modify disease-specific risk factors or confer risk for in-hospital complications. They can also cause changes in laboratory values; however, studies are limited to observational studies and case series. Some data are derived and extrapolated from cisgender populations. There are also unique systems-based concerns, including lack of procedures for standardized collection of gender identity and lack of sufficiently comprehensive electronic health record platforms. Vulnerabilities exist for hospitalized transgender patients in the transition from the inpatient to outpatient care that require dedicated institutional efforts to address. CONCLUSIONS AND RELEVANCEClinicians should learn how to engage with transgender patients, appreciate that unique anatomy or the use of gender-affirming hormones may affect the prevalence of certain disease (eg, cardiovascular disease, venous thromboembolism, and osteoporosis), and be prepared to manage specific issues, including those related to hormone therapy. Health care facilities should work toward providing inclusive systems of care that correctly identify and integrate information about transgender patients into the electronic health record, account for the unique needs of these patients within the facility, and through education and policy create a welcoming environment for their care.

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Caring for transgender patients with epilepsy

Abstract: Transgender patients with epilepsy face significant social and medical challenges. Interactions between medical gender-affirming treatments and AEDs are common, and management must depend on knowledge of these interactions to provide appropriate treatment.

Cited by 24 publications

References 46 publications

Headache in transgender and gender‐diverse patients: A narrative review

Headache in transgender and gender‐diverse patients: A narrative review

The Evolving Role of Pharmacists in Transgender Health Care

Acute Clinical Care for Transgender Patients

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