Journal article
Impact of sex used for assignment of reference intervals in a population of patients taking gender-affirming hormones
Journal of clinical & translational endocrinology, Vol.36, 100350
06/2024
DOI: 10.1016/j.jcte.2024.100350
PMCID: PMC11087993
PMID: 38737625
Abstract
[Display omitted]
•For the population taking gender-affirming hormones, legal sex impacts normal/abnormal flagging of laboratory tests.•Creatinine and liver enzymes are the most frequently ordered tests potentially impacted by gender-affirming hormones.•Sexual orientation/gender identity (SOGI) fields can help identify those potentially taking gender-affirming hormones.•Cardiac biomarkers and iron studies merit further investigation for the impact of gender-affirming hormones.
Gender-affirming hormone therapy with either estradiol or testosterone for transgender persons can significantly impact chemistry and hematology laboratory tests. The sex used for assignment of reference intervals (RIs) in the electronic health record (EHR) will influence normal/abnormal flagging of test results.
To analyze common non-hormonal laboratory tests with sex-specific RIs ordered in patients with sexual orientation/gender identify (SOGI) field differences (one or more differences between legal sex, sex assigned at birth, and gender identity) in the EHR at an academic medical center in midwestern United States.
We utilized a previously characterized data set of patients at our institution that included chart review information on gender identity and gender-affirming therapy. We focused on the subset of these patients that had orders for 18 common laboratory tests in calendar year 2021.
A total of 1336 patients with SOGI field differences (1218 or 91.2% identifying as gender-expansive; 892 or 66.8% receiving estradiol or testosterone as gender-affirming therapy) had a total of 9374 orders for 18 laboratory tests with sex-specific RIs. Hemoglobin, creatinine, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and high-density lipoprotein were the most frequently ordered tests. For patients taking estradiol, 128 of 970 (13.2%) creatinine and 39 of 193 (20.2%) hemoglobin measurements were within the RI for one sex but not the other. For those taking testosterone, 119 of 531 (22.4%) creatinine and 49 of 120 (40.8%) hemoglobin measurements were within the RI for one sex but not the other. Values above the cisgender female RI but within the cisgender male RI were common for hemoglobin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase in patients taking testosterone.
Clinicians should be aware of the potential impact of gender-affirming therapy on laboratory tests and what sex/gender is being used in the EHR to assign RIs.
Details
- Title: Subtitle
- Impact of sex used for assignment of reference intervals in a population of patients taking gender-affirming hormones
- Creators
- Matthew D. Krasowski - University of Iowa Hospitals and ClinicsNicole G. Hines - University of IowaKatherine L. Imborek - University of IowaDina N. Greene - University of Washington
- Resource Type
- Journal article
- Publication Details
- Journal of clinical & translational endocrinology, Vol.36, 100350
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jcte.2024.100350
- PMID
- 38737625
- PMCID
- PMC11087993
- ISSN
- 2214-6237
- eISSN
- 2214-6237
- Language
- English
- Electronic publication date
- 06/2024
- Academic Unit
- Pathology; Family and Community Medicine
- Record Identifier
- 9984627153002771
Metrics
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