Introduction:
Week 7 of the course provided learning materials to improve the healthcare of LGBTQ+ individuals. This assignment applies the principles of this material and allows the student to reflect on resources and information available in relation to a chosen case scenario.
Part I: Scenario(s):
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1. Scenario #1: Maria is a 42-year-old transgender woman currently on hormone therapy who presents for her regularly scheduled follow-up appointment. She mentions a lump in her left breast during your physical exam. She is worried it could be cancer and asks, “will this impact my ability to continue hormones?”
2. Scenario #2: Philip is a cisgender man who presents to the Infectious Disease office for his routine follow-up for HIV management. He tells you that he and his partner John are considering starting a family. He asks you what his options might be regarding becoming a father with HIV?
3. Scenario #3: Jennifer is a long-time pulmonary patient whom you see in morning rounds while hospitalized for COPD exacerbation. She shares with you that she has been stressed lately because recently her adolescent son told her he is questioning his sexuality and she doesn’t know how to support him. She asks you for information for helping her talk with her son and how to support his mental and physical health.
Part II: Prompts for Assignment:
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1. Chose one scenario above to answer the following questions. Be sure to answer ALL of the following questions and prompts based upon your chosen scenario (from above):
o What is your initial, compassionate response to this patient? How would you support this at the moment, regarding their immediate concern? What resources are available in your current or previous institutions for LGBTQ patients?
o Search the peer-reviewed literature regarding your chosen scenario topic. What and how much information were you able to find? How does this compare to information gathered from a search on an open-access search engine (such as Google)?
o Reflection: How easy or difficult was it to find reliable information? How did you assess the validity of the information? Were you surprised by any of the information or misinformation you found?
Directions for Assignment:
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1. Answer ALL of the Part II Questions and prompts based upon your chosen scenario (from Part I).
2. Use APA formatting for references (in-text and reference page).
 Font: Times New Roman, size 12.
 No title page is required.
 Double-spacing is required.
3. Paper should be no more than 1 page (not including references).
4. Bullet points will not be accepted, but you may label each answer/section.
5. Refer to the grading rubric (below) for a breakdown of achieving various levels of points.
6. Include a minimum of 2 peer-reviewed, evidence-based references to support your reflection.
 At least one reference must be different from the articles posted on the course board or the textbook.
 Include an APA reference section.
 References from lay media/publications will not be accepted as supporting evidence.
 Only references from the last 10 years will be accepted.
7. All assignments must be submitted as a Word document; only .doc, .docx, or .pdf will be accepted.
 Any assignments that cannot be opened (i.e. not format from the above list) will be asked to resubmit and are subject to late submission penalties.
8. Late submissions will incur a loss of 5 points for each calendar day that the assignment is delayed. No assignments will be accepted if more than 3 days late, and the grade will be a zero.
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Scenario #1: Maria is a 42-year-old transgender woman currently on hormone therapy who presents for her regularly scheduled follow-up appointment. She mentions a lump in her left breast during your physical exam. She is worried it could be cancer and asks, “will this impact my ability to continue hormones?”

• Initial response: Acknowledge her concern and empathize with her. Reassure her that she has come to the right place and that we will provide her with the best possible care. Inform her that we will perform a biopsy to determine the nature of the lump, and that we will also work with her to ensure that she can continue hormone therapy, if appropriate.

• Resources: Our institution has an LGBTQ+ Health Center that provides comprehensive care, including hormone therapy, cancer screenings, and other healthcare services tailored to the needs of LGBTQ+ individuals. We also have a multidisciplinary team of healthcare providers who work together to provide coordinated care for transgender patients.

• Literature search: The literature shows that transgender individuals are at increased risk of certain cancers, including breast cancer. However, there is limited research on the impact of hormone therapy on breast cancer risk, and the available evidence suggests that it is not clear whether hormone therapy increases the risk of breast cancer in transgender women. Treatment for breast cancer in transgender individuals can be complex, as it may involve discontinuation of hormone therapy and consideration of gender-affirming surgery.

• Reflection: It was challenging to find reliable information on the specific question of whether breast cancer treatment would impact hormone therapy in transgender women. However, I was able to find some useful information on cancer screening and treatment in transgender individuals more broadly, which helped me to understand some of the unique challenges that transgender individuals may face in the context of cancer care. I assessed the validity of the information by checking the credentials of the authors and ensuring that the sources were from reputable, peer-reviewed journals.

References:

Giordano SH et al. Breast Cancer in Men. New England Journal of Medicine. 2018; 378(24):2311-20.
MacGregor CA et al. Transgender Health Care: Improving Access to Gender-Affirming Care. Am Fam Physician. 2018;97(11):729-37.