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Impact of sex used for assignment of reference intervals in a population of patients taking gender-affirming hormones.
Krasowski, Matthew D; Hines, Nicole G; Imborek, Katherine L; Greene, Dina N.
Afiliação
  • Krasowski MD; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
  • Hines NG; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
  • Imborek KL; Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
  • Greene DN; Department of Family Medicine, University of Iowa, Iowa City, IA, 52242, USA.
J Clin Transl Endocrinol ; 36: 100350, 2024 Jun.
Article em En | MEDLINE | ID: mdl-38737625
ABSTRACT

Background:

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.

Objective:

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.

Methods:

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.

Results:

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.

Conclusions:

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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: J Clin Transl Endocrinol Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: J Clin Transl Endocrinol Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos