From the Guidelines
For a minor transgender man, the recommended laboratory tests include a comprehensive metabolic panel, complete blood count, lipid panel, and baseline hormone levels, with individualized testing regimens based on the patient's age, medical history, and treatment goals, as supported by the most recent study 1.
Key Laboratory Tests
- Comprehensive metabolic panel to monitor electrolytes, blood urea nitrogen, and creatinine levels, which may be influenced by gender-affirming hormone therapy (GAHT) 1
- Complete blood count to track hemoglobin and hematocrit levels, as testosterone can increase red blood cell production, potentially leading to polycythemia 1
- Lipid panel to monitor cardiovascular risk factors, as testosterone may affect cholesterol levels 1
- Baseline hormone levels, including testosterone, estradiol, luteinizing hormone, and follicle-stimulating hormone, to establish a baseline health status and monitor physiological changes during GAHT 1
Considerations for GAHT
- If testosterone therapy is being considered, liver function tests should be monitored regularly, as GAHT can influence liver enzyme measurements 1
- For individuals on GAHT for ≥12 months, many laboratory values should be interpreted based on their affirmed gender, while those who have stopped GAHT for ≥3 months should have laboratory values interpreted based on their sex assigned at birth 1
Additional Recommendations
- Psychological assessment and support are essential components of comprehensive care for transgender youth, as they may face unique challenges and stressors that can impact their mental health and well-being 1
- Bone density scans may be appropriate depending on the patient's age and treatment plan, as GAHT can affect bone density and increase the risk of osteoporosis 1
- The specific testing regimen should be individualized based on the patient's age, medical history, and treatment goals, with more frequent monitoring typically needed when initiating hormone therapy 1
From the FDA Drug Label
Hemoglobin and hematocrit should be checked periodically for polycythemia in patients who are receiving high doses of androgens. Hemoglobin and hematocrit levels (to detect polycythemia) should be checked periodically in patients receiving long-term androgen administration. The necessary labs for a minor transgender man taking testosterone include:
- Hemoglobin and hematocrit levels to detect polycythemia 2 3 It is also important to monitor:
- Serum cholesterol levels, as androgen therapy may increase them 2 3
From the Research
Laboratory Tests for Minor Transgender Men
To determine the necessary laboratory tests for a minor transgender man, it is essential to consider the effects of hormone therapy on various laboratory parameters.
- Hematology tests:
- Endocrinology tests:
- Total and free testosterone, and Sex Hormone-Binding Globulin (SHBG) can be interpreted using reference intervals for cisgender men 5
- Prolactin can be interpreted using reference intervals for cisgender women 5
- Estradiol, Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH), Anti-Müllerian Hormone (AMH), and Dehydroepiandrosterone Sulfate (DHEAS) require reference intervals specific to the transmasculine population 5
- Other tests:
- Iron studies, cardiac troponin, and creatinine may be affected by sex steroids or body size and require careful interpretation 6
Considerations for Laboratory Test Interpretation
When interpreting laboratory tests for transgender individuals, it is crucial to consider the impact of gender-affirming hormone therapy on laboratory parameters.
- Reference ranges for the affirmed gender should be used, except for Prostate-Specific Antigen (PSA) or cardiac troponin, which depend on organ size 6
- Clinicians should be aware of the potential effects of hormone therapy on laboratory tests and use appropriate reference intervals to ensure accurate interpretation 5, 6