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Interestingly, our patient did have low free testosterone levels as well as generalized fatigue which both improved after testosterone therapy by her endocrinologist. We would recommend to all patients with testosterone-related problems to discuss the possible risks and benefits of treatment together with their physician. CASE 3: Female Male Sex Reassignment The Patient: An 18 year-old American student. It was discovered a year ago that she was transgender. She was born female and in her early college years was wearing a pink lab coat, a pink dress, dresses for Halloween and a pink scarf around her neck. She would frequently show her breasts and genitalia. She was born female and chose to be female and live as "female" for the rest of her life. She has not had sex reassignment surgery (SRS) and is currently on estrogen-based testosterone therapy. As you can see, she lives a very feminine life. She lives in an urban metropolitan area and is somewhat outgoing. She doesn't feel comfortable in public places and is very shy. The Gender-Affirming Clinic: Before starting testosterone therapy, we made it a goal of ours to work with all our transgender women patients so they could improve their condition without the use of hormone therapy. The first appointment was with this patient, which was in October, 2010. The day before the appointment we had a patient that had undergone surgical vaginoplasty. This patient had a very pronounced chest deformity and was unable to continue her hormone therapy because of the new surgery, which required extensive hospitalization. The patient was referred to our clinic and was evaluated in March, 2011, and we followed up with her over the following couple of months until in August, 2011 the patient started testosterone, which was recommended to her by her primary care physician. The patient started hormone therapy at her regular clinic of physician and psychologist as prescribed. At her second appointment the patient received a "CARE PLAN" that outlined which hormone she could use and what schedule she would follow. At her third appointment the patient was given more detailed information about the care plan and we began hormones two months earlier than the scheduled dates. What have we learned so far about "CARE PLAN" and how would you use this for your transgender patients with the same goals in mind? The patient was a good subject to study, because while she was on hormone therapy she was very supportive of her transition, she was not as concerned as others to take her hormones earlier and, in most aspects the patient made the same decision as the patient in our earlier patient study. So to some, maybe because she had already received a "CARE Similar articles: