Matthew D. Krasowski , Nicole G. Hines , Katherine L. Imborek , Dina N. Greene
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The sex used for assignment of reference intervals (RIs) in the electronic health record (EHR) will influence normal/abnormal flagging of test results.</p></div><div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":46328,"journal":{"name":"Journal of Clinical and Translational Endocrinology","volume":"36 ","pages":"Article 100350"},"PeriodicalIF":4.2000,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214623724000218/pdfft?md5=1d1ac92efa9497b47d10f9bcf54a65cb&pid=1-s2.0-S2214623724000218-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Impact of sex used for assignment of reference intervals in a population of patients taking gender-affirming hormones\",\"authors\":\"Matthew D. 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The sex used for assignment of reference intervals (RIs) in the electronic health record (EHR) will influence normal/abnormal flagging of test results.</p></div><div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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. 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引用次数: 0
摘要
背景变性人使用雌二醇或睾酮进行性别确认激素治疗会对化学和血液学实验室检测产生重大影响。目的分析美国中西部一家学术医疗中心的电子病历中，性取向/性别认同（SOGI）领域差异（法定性别、出生时性别和性别认同之间的一个或多个差异）患者所接受的具有性别特异性参考区间（RI）的常见非激素化验项目。方法我们利用了本机构以前的患者数据集，其中包括有关性别认同和性别确认疗法的病历审查信息。结果共有 1336 名患者存在 SOGI 领域差异（其中 1218 人或 91.2% 认同为性别开放；892 人或 66.8% 接受雌二醇或睾酮作为性别确认疗法），共收到 9374 份 18 项具有性别特异性 RI 的化验单。血红蛋白、肌酐、碱性磷酸酶、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶和高密度脂蛋白是最常见的化验项目。在服用雌二醇的患者中，970 人中有 128 人（13.2%）的肌酐测量值和 193 人中有 39 人（20.2%）的血红蛋白测量值符合一种性别的 RI 标准，但不符合另一种性别的 RI 标准。在服用睾酮的人群中，531 人中有 119 人（22.4%）的肌酐测量值和 120 人中有 49 人（40.8%）的血红蛋白测量值在一种性别的 RI 范围内，而另一种性别的测量值不在 RI 范围内。在服用睾酮的患者中，血红蛋白、碱性磷酸酶、丙氨酸氨基转移酶和天门冬氨酸氨基转移酶的数值高于顺式性别女性的 RI，但在顺式性别男性的 RI 范围内的情况很常见。
Impact of sex used for assignment of reference intervals in a population of patients taking gender-affirming hormones
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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