Hormone therapy in transgender adults – guidelines in practice for pathologists

Abstract

Transgender (trans) people include people with a binary (i.e., male or female) and non-binary identity and are one of the most marginalised groups in our community with a high burden of mental health conditions and suicidality. Due to discrimination, many fear healthcare settings. Acceptance, understanding and gender-affirming care can significantly improve distress and allay fear which is important even within pathology departments. Whilst phlebotomists will need to abide by policies for patient identification, an individual’s preferred name and pronoun should be used in interactions. Legal sex as registered with Medicare may not reflect sex-assigned at birth or inform on use of feminising or masculinising hormone therapy which impacts upon sex-specific reference ranges (i.e., haemoglobin, eGFR). There are also impacts in anatomical pathology reporting such as in providing histology of reproductive organs which may not align with gender markers. In the ideal setting, information including legal name, preferred name, sex-assigned at birth, gender identity and use of feminising or masculinising hormone therapy should be available to allow phlebotomists, pathologists and treating clinicians to provide gender-affirming care and clinically-relevant reports. Moreover, reporting of dual male and female sex-specific reference ranges may be useful for people who have recently commenced gender-affirming hormone therapy or in those using non-standard hormone regimens (i.e., low dose testosterone). Implementation of these changes presents a myriad of information system challenges but also an opportunity to ensure the highest standards of care for the Australian trans community.