Interpreting Laboratory Results in Transgender Patients on Hormone Therapy

Roberts, Tiffany K.; Kraft, Colleen S.; French, Deborah; Ji, Wuyang; Wu, Alan H.B.; Tangpricha, Vin; Fantz, Corinne R.

doi:10.1016/j.amjmed.2013.10.009

Cited by 92 publications

(55 citation statements)

References 10 publications

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“…This may be due to the limited doses used, but is a reassuring finding. MtF creatinine levels may more closely resemble the cisgender male creatinine range than the cisgender female creatinine range [6]. This study found a decrease in creatinine for the MtF cohort at Visit 1, but no significant changes at Visit 2; lack of statistical significance is likely due to the smaller number of subjects with data at Visit 2.…”

Section: 0 Discussionmentioning

confidence: 82%

“…One retrospective study compared transgender and cisgender lipid profiles. While there was a statistically significant difference between cisgender men and cisgender women, transgender women HDL levels were found to lie intermediate to the cisgender averages, not significantly deviating from either [6]. Two papers suggest that there is no change in either total cholesterol or HDL after hormone therapy for transgender women [7], [8].…”

Section: 0 Discussionmentioning

confidence: 99%

“…Two papers suggest that there is no change in either total cholesterol or HDL after hormone therapy for transgender women [7], [8]. Additionally, two papers note a significant increase in triglycerides for transgender women [6], [8], while other studies reported no change in triglycerides [7]. This study found a significant increase (p < 0.01) in HDL at Visit 1, as would be expected if the lipid profile of the trans women were shifting to resemble that of average cisgender women.…”

Section: 0 Discussionmentioning

confidence: 99%

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Metabolic Effects Of Hormone Therapy In Transgender Patients

Fernandez

Tannock

2016

Endocrine Practice

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Objective Transgender patients may seek hormone therapy to induce physical changes to simulate their expressed or experienced gender. However, many providers are uncomfortable prescribing transgender hormones due to fears over safety. The goal of this study was to determine if transgender hormone therapy with estrogen and spironolactone for male-to-female (MtF) patients or with testosterone for female-to-male (FtM) patients had adverse anthropomorphic or metabolic effects. Methods This retrospective chart review study analyzed changes over time for 33 MtF and 19 FtM endocrine clinic patients at an academic endocrine practice with follow up for up to 18 months after hormone initiation. Results Compared to baseline labs obtained prior to initiation of hormone therapy statistically significant changes for the MtF cohort included an increase in HDL and decrease in creatinine; however, triglycerides did not show a statistically significant change. In the FtM cohort, there was a statistically significant increase in body mass index, creatinine, hemoglobin, and hematocrit. These changes were minimal for both cohorts. Conclusion In our practice, hormone therapy was found to be safe in this retrospective study.

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confidence: 82%

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confidence: 99%

Section: 0 Discussionmentioning

confidence: 99%

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Metabolic Effects Of Hormone Therapy In Transgender Patients

Fernandez

Tannock

2016

Endocrine Practice

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“…In a large retrospective study of transgender population, variety of several laboratory tests, including hemoglobin and hematocrit, were consistently changes in measurand levels in male-to-female that did not fit into the standard male and female reference ranges. 4 The researchers suggested that urgent need of new reference ranges for transgender patients.Hormone replacement therapy in transgender patients, like testosterone, results in an increase in the hemoglobin and hematocrit as well as an increase in red blood cell count. However, if this increases to levels higher than is normal in males, it may cause problems with circulation, such as blood clots, strokes and heart attacks.…”

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Hematological parameters in Transgender Persons

Kandhro¹

2016

HTIJ

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Submit Manuscript | http://medcraveonline.com nonbinary, an all-inclusive term that includes specific genders, such as genderqueer, agender, bigender, and genderfluid. 1According to the findings of the Survey of National Transgender Discrimination, 19% had been refused medical care, 30% had been verbally or physically harassed while attempting to receive medical care, and 48% were unable to afford medical care.2 At the same time as, lack of training or less training received by the medical health professionals in caring for transgender patients, and reliable information about complications and long-term outcomes of trangender patients are limited. 3Gaining cultural visibility of being transgender population, it becomes more complicated to establish guidelines and recommendations for screening and treatment. The major challenge faced by laboratory staff for reporting clinical laboratory results is the lack of a standardized definition of "normal" laboratory test values for transgender patient population. The Interpretation of laboratory data in transgender patients becomes complicated for laboratory tests that have sex-specific reference ranges, like liver enzymes, creatinine, hemoglobin/hematocrit levels. In a large retrospective study of transgender population, variety of several laboratory tests, including hemoglobin and hematocrit, were consistently changes in measurand levels in male-to-female that did not fit into the standard male and female reference ranges. 4 The researchers suggested that urgent need of new reference ranges for transgender patients.Hormone replacement therapy in transgender patients, like testosterone, results in an increase in the hemoglobin and hematocrit as well as an increase in red blood cell count. However, if this increases to levels higher than is normal in males, it may cause problems with circulation, such as blood clots, strokes and heart attacks.5 Also, increased hemoglobin and hematocrit levels as compared to controls in female-to-male transgender patients which are on testosterone therapy is observed.6 However, male-to-female transgender patients who are on estrogen therapy, have hemoglobin and hematocrit levels similar to female controls.7 Therefore, establishing guidelines and reference ranges for transgender persons is of greater concern to resolve the complications. The major risk factors of male-to-female hormone replacement therapy are Venous thrombosis events and increased triglyceride as have been reported by The Standard Care (SOC) released by the World Professional Association for Transgender Health (WPATH).8 While, the greatest risk factors of female-to-male hormone replacement therapy is Polycythemia, reported by (WPATH-SOC). 9It is unclear in hormone replacement therapy transgender patients, which reference ranges best fit for a transgender patient (sex at birth or identified gender) or whether new reference ranges require to be established to adequately and safely monitor these patients. The Clinical Laboratory Standards Institute's (CLSI) guideline (C28-A3) ...

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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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Interpreting Laboratory Results in Transgender Patients on Hormone Therapy

Cited by 92 publications

References 10 publications

Metabolic Effects Of Hormone Therapy In Transgender Patients

Metabolic Effects Of Hormone Therapy In Transgender Patients

Hematological parameters in Transgender Persons

Acute Clinical Care for Transgender Patients

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