Sara Oswald, ASCLS Developing Professionals Forum Vice Chair

A few months ago, one of my work colleagues was visibly upset when she got off the phone with a provider. The chemistry results for this patient were all out of whack, and when she called to report the issue to the provider, she was informed this patient was transgender and on hormone therapy. “These people are so annoying!” she vented. “Why can’t they just put down what they are?”

I found myself in the unusual position of both fully understanding her frustration with confusing test results, but also having close friends in the transgender community and understanding the many challenges they face with their healthcare. I was able to explain some of this to my coworker, while also trying not to preach. Because, I get it. It is frustrating when we aren’t given the information we need to do our jobs. But I also get that transgender people are dealing with a lot of frustrations in this process, too.

“Those of us who are cisgender think nothing of marking M or F on [healthcare] forms, but transgender people know that what they mark may impact how others perceive them, what pronouns are used when people talk to them and about them, and even the quality of healthcare they may receive.”

First, to address my coworker’s question, “Why can’t they just write down what they are?” That’s actually quite a conundrum. Currently most healthcare forms are set up to accept either male or female. There is no transgender man or transgender woman, or even a separate question asking what sex they were at birth. Do they select the sex listed on their birth certificate or the one on their driver’s license? Do they select what matches their chromosomes, or what matches the current phenotype of their body?

Those of us who are cisgender think nothing of marking M or F on these forms, but transgender people know that what they mark may impact how others perceive them, what pronouns are used when people talk to them and about them, and even the quality of healthcare they may receive.

But the real issue with wanting transgender people to mark the sex they were assigned at birth on the intake form is that it doesn’t resolve the problems we have in the lab. Multiple studies have reported significant changes in basic chemistry, endocrine, and hematologic parameters in transgender patients receiving hormone therapy. These changes put them outside the normal ranges for either sex.1

There are several studies currently taking place working toward establishing reference ranges for these individuals, but due to the diversity of the population (i.e., those who pursue gender reassignment surgery vs. those who remain on hormone therapy vs. some combination of the two), these reference ranges will be slow to materialize, if they come at all.2

In the meantime, unless a transgender individual is lucky enough to live near a specialty clinic, they may be the only transgender patient their doctor sees. The physician may not understand what tests to order to monitor the patient’s hormone therapy, or the long-term health effects that can occur if the hormone therapy is not properly monitored, such as venous thromboembolism, fractures, cardiovascular disease, stroke, and various hormone-dependent cancers.3

So, what can we do? How can we in the lab advocate for these patients? First, we can honor their humanity. These people are not “other,” they are sisters, brothers, daughters, and sons. They are our friends and colleagues. We can speak of these patients respectfully and use their preferred pronouns even when they are not in the room. Secondly, we can push for more gender-inclusive healthcare intake forms and clinical software. And finally, we can advocate for legislation and research that will provide us with the reference ranges we need to provide transgender people with the care they need to live long and healthy lives.

References
  1. Goldstein, Zil et al. “When Gender Identity Doesn’t Equal Sex Recorded at Birth: The Role of the Laboratory in Providing Effective Healthcare to the Transgender Community.” Clinical Chemistry vol. 63,8. August 1, 2017.
  2. Krasowski, Matthew and Humble, Robert. “The Clinical Laboratory and Informatics Challenges of Transgender Patient Care.” AACC Academy Scientific Shorts. June 17, 2019.
  3. Delgado-Ruiz, Rafael et al. “Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy.” Journal of Clinical Medicine vol. 8,6 784. June 1, 2019.

Sara Oswald is in the MLT Program at Colorado Mesa University in Grand Junction, Colorado.