Clinical labs key to improving quality of health care for transgender individuals

Dina N. Greene

Clinical laboratories are key to breaking down health care barriers faced by transgender individuals, according to a review published in Clinical Chemistry.

“Understanding gender incongruence, the clinical changes associated with gender transition and systemic barriers that maintain a gender/sex binary are key to providing adequate health care to the transgender community,” Dina N. Greene, PhD, DABCC, assistant professor in the department of laboratory medicine and associate director of chemistry at University of Washington, said in a press release.

Patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ) often experience increased anxiety and fear discrimination in medical situations. LGBTQ cancer survivors consistently report lower satisfaction with medical care, and gay, bisexual and transgender men who survive cancer appear more likely to experience depression or relationship difficulties.

Barriers to care exist in these communities, as well.

In their review, Greene and colleagues examined gaps in knowledge related to transgender health care.

They found transgender-appropriate reference interval studies are nearly absent in the medical literature. They also determined improvements in the physiological understanding, electronic medical system recognition and overall social awareness of transgender individuals are needed.

The clinical laboratory can play a key role in accomplishing this, they concluded.

HemOnc Today spoke with Greene about the review, the implications of the researchers’ findings, and the strategies that can be implemented to break down health care barriers faced by this patient population.

 

Question: What prompted this review?

Answer: This was an invited review. The journal decided that content on transgenders was needed. The journal had not highlighted anything to do with transgender health and medicine before. They saw a need and they knew I had background knowledge and expertise to fulfill this. I have had an active interest in transgender health and education. I have given several talks and familiarized myself with the literature, so I have become known for understanding the different concepts that are involved with transgender. Most of the time it is gender 101-type content, with the added bonus of how sex influences laboratory results.

 

Q: What did you find in your review of the literature?

A: Literature on transgenders is very limited. There is not much known about how transitioning affects laboratory values. For example, we need to know what normal clinical lab values are when someone transitions their gender, particularly when it comes to laboratory tests that have sex-specific cutoffs.

 

Q: Why are these findings so significant?

A: The findings outline that there is a knowledge gap in the literature, and that there are a lot of system barriers and discrimination that happens that can be avoided if people were more educated.

 

Q: Can you offer specific suggestions that can be implemented or considered to bridge this gap?

A: Clinical labs should develop institution-wide protocols for identifying transgender individuals that highlight the different electronic medical record systems where sex and gender identity both need to recognized. Additionally, when sex-specific tests — such as those for PSA or pregnancy — are seemingly ordered for a patient of the opposite sex, labs should not cancel these tests and should properly flag the results. Another critical unmet need is for labs to develop precise reference intervals for transgender patients who take hormone therapy. Until these reference intervals are established, lab professionals should use hormone therapy status and clinical judgment to assess abnormal test results in transgender patients.

 

Q: What should future research entail?

A: Future research should focus on establishing reference intervals for common laboratory values that are known to be influenced by sex, as well as understanding if there are differences in these laboratory values depending on if the person transitioned as a child or as an adult. There has been an increase of pediatric transgender health care services, but the availability of transgender health care services in the geriatric populations is scarce.

 

Q: Is there anything else that you would like to mention?

A: It is helpful for people to understand that being transgender in and of itself is not a pathology but an identity. Gender is something unique to every individual, and it influences the way we are perceived and relate to the world. That can be really hard for some people to grasp when they have never experienced a discrepancy between their sex assigned at birth and gender, but having the awareness to relate to others’ differences is universally valuable. – by Jennifer Southall

 

Reference:

Goldstein Z, et al. Clin Chem. 2017;doi:10.1373/clinchem.2016.258780.

 

For more information:

Dina N. Greene, PhD, DABCC, can be reached at University of Washington, Box 357110, 1959 NE Pacific St., NW120, Seattle, WA 98195; email: dngreene@uw.edu.

 

Disclosure: Greene reports no relevant financial disclosures.

Dina N. Greene

Clinical laboratories are key to breaking down health care barriers faced by transgender individuals, according to a review published in Clinical Chemistry.

“Understanding gender incongruence, the clinical changes associated with gender transition and systemic barriers that maintain a gender/sex binary are key to providing adequate health care to the transgender community,” Dina N. Greene, PhD, DABCC, assistant professor in the department of laboratory medicine and associate director of chemistry at University of Washington, said in a press release.

Patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ) often experience increased anxiety and fear discrimination in medical situations. LGBTQ cancer survivors consistently report lower satisfaction with medical care, and gay, bisexual and transgender men who survive cancer appear more likely to experience depression or relationship difficulties.

Barriers to care exist in these communities, as well.

In their review, Greene and colleagues examined gaps in knowledge related to transgender health care.

They found transgender-appropriate reference interval studies are nearly absent in the medical literature. They also determined improvements in the physiological understanding, electronic medical system recognition and overall social awareness of transgender individuals are needed.

The clinical laboratory can play a key role in accomplishing this, they concluded.

HemOnc Today spoke with Greene about the review, the implications of the researchers’ findings, and the strategies that can be implemented to break down health care barriers faced by this patient population.

 

Question: What prompted this review?

Answer: This was an invited review. The journal decided that content on transgenders was needed. The journal had not highlighted anything to do with transgender health and medicine before. They saw a need and they knew I had background knowledge and expertise to fulfill this. I have had an active interest in transgender health and education. I have given several talks and familiarized myself with the literature, so I have become known for understanding the different concepts that are involved with transgender. Most of the time it is gender 101-type content, with the added bonus of how sex influences laboratory results.

 

Q: What did you find in your review of the literature?

A: Literature on transgenders is very limited. There is not much known about how transitioning affects laboratory values. For example, we need to know what normal clinical lab values are when someone transitions their gender, particularly when it comes to laboratory tests that have sex-specific cutoffs.

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Q: Why are these findings so significant?

A: The findings outline that there is a knowledge gap in the literature, and that there are a lot of system barriers and discrimination that happens that can be avoided if people were more educated.

 

Q: Can you offer specific suggestions that can be implemented or considered to bridge this gap?

A: Clinical labs should develop institution-wide protocols for identifying transgender individuals that highlight the different electronic medical record systems where sex and gender identity both need to recognized. Additionally, when sex-specific tests — such as those for PSA or pregnancy — are seemingly ordered for a patient of the opposite sex, labs should not cancel these tests and should properly flag the results. Another critical unmet need is for labs to develop precise reference intervals for transgender patients who take hormone therapy. Until these reference intervals are established, lab professionals should use hormone therapy status and clinical judgment to assess abnormal test results in transgender patients.

 

Q: What should future research entail?

A: Future research should focus on establishing reference intervals for common laboratory values that are known to be influenced by sex, as well as understanding if there are differences in these laboratory values depending on if the person transitioned as a child or as an adult. There has been an increase of pediatric transgender health care services, but the availability of transgender health care services in the geriatric populations is scarce.

 

Q: Is there anything else that you would like to mention?

A: It is helpful for people to understand that being transgender in and of itself is not a pathology but an identity. Gender is something unique to every individual, and it influences the way we are perceived and relate to the world. That can be really hard for some people to grasp when they have never experienced a discrepancy between their sex assigned at birth and gender, but having the awareness to relate to others’ differences is universally valuable. – by Jennifer Southall

 

Reference:

Goldstein Z, et al. Clin Chem. 2017;doi:10.1373/clinchem.2016.258780.

 

For more information:

Dina N. Greene, PhD, DABCC, can be reached at University of Washington, Box 357110, 1959 NE Pacific St., NW120, Seattle, WA 98195; email: dngreene@uw.edu.

 

Disclosure: Greene reports no relevant financial disclosures.