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Marina Klein, MD, MS

Marina Klein, MD, MS

McGill University

Core Faculty

Professor of Medicine
McGill University
Montreal, Canada

131 Steuart St, Suite 500, San Francisco, CA 94105

Phone: (415) 544-9400 | info@iasusa.org

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Practice Question of the Week

November 28, 2022: Considerations When Starting Gender-Affirming Hormone Therapy

A 48-year-old transgender woman presents seeking gender-affirming care. Past medical history includes HIV, diabetes mellitus type II, and hyperlipidemia. Her medications include rosuvastatin 10 mg daily, metformin 500 mg twice daily, and bictegravir/emtricitabine/tenofovir alafenamide. She currently smokes 15 cigarettes per day. What should you consider when starting gender-affirming hormone therapy?
- A. Start estrogen and spironolactone regardless of smoking status
- B. Start transdermal estrogen and spironolactone along with smoking cessation counseling
- C. Do not begin hormone therapy until the patient has stopped smoking
- D. Begin spironolactone only

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