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Reference Intervals for Clinical Chemistry Analytes for Transgender Men and Women on Stable Hormone Therapy
Journal article   Open access   Peer reviewed

Reference Intervals for Clinical Chemistry Analytes for Transgender Men and Women on Stable Hormone Therapy

Robert M Humble, Dina N Greene, Robert L Schmidt, Gabrielle Winston McPherson, Jessica Rongitsch, Katherine L Imborek, Nicole Nisly, Nancy J Dole, Susan K Dane, Janice Frerichs, …
The journal of applied laboratory medicine, Vol.7(5), pp.1131-1144
05/18/2022
DOI: 10.1093/jalm/jfac025
PMID: 35584132
url
https://doi.org/10.1093/jalm/jfac025View
Published (Version of record) Open Access

Abstract

Abstract Background Gender-affirming hormone therapy with either estradiol or testosterone is commonly prescribed for transgender individuals. Masculinizing or feminizing hormone therapy may impact clinical chemistry analytes, but there is currently a lack of published reference intervals for the transgender population. Methods Healthy transgender and nonbinary individuals who had been prescribed either estradiol (n = 93) or testosterone (n = 82) for at least 12 months were recruited from primary care and internal medicine clinics specializing in transgender medical care. Electrolytes, creatinine, urea nitrogen, enzymes (alkaline phosphatase, ALK; alanine aminotransferase, ALT; aspartate aminotransferase, AST; gamma-glutamyltransferase, GGT), hemoglobin A1c, lipids [total cholesterol, high-density lipoprotein (HDL), triglycerides], and high-sensitivity C-reactive protein (hsCRP) were measured on 2 clinical chemistry platforms. Reference intervals (central 95%) were calculated according to Clinical Laboratory Standards Institute guidelines. Results There was minimal impact of gender-affirming hormone therapy on electrolytes, urea nitrogen, hemoglobin A1c, and hsCRP. In general, the enzymes studied shifted toward affirmed gender. Creatinine values for both transgender cohorts overlaid the reference interval for cisgender men, with no shift toward affirmed gender for the estradiol cohort. The effects on lipids were complex, but with a clear shift to lower HDL values in the testosterone cohort relative to cisgender women. Conclusions Transgender individuals receiving either masculinizing or feminizing hormone therapy showed significant changes in some analytes that have sex-specific variation in the cisgender population. The clearest shifts toward affirmed gender were seen with enzymes for the estradiol and testosterone cohorts and with creatinine and HDL in the testosterone cohort.

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