Hematology reference intervals for transgender adults on stable hormone therapy

Greene, Dina N.; McPherson, Gabrielle Winston; Rongitsch, Jessica; Imborek, Katherine L; Schmidt, Robert L.; Humble, Robert M.; Nisly, Nicole; Dole, Nancy; Dane, Susan K; Frerichs, Janice; Krasowski, Matthew D.

doi:10.1016/j.cca.2019.02.011

Cited by 54 publications

(34 citation statements)

References 19 publications

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“…Two studies 41 51 used both follow-up and crosssectional designs with cisgender controls. Six studies 18 Review used an exclusively cross-sectional design; three comparing transwomen on GAHT with cisgender controls 18 53 54 and three comparing transwomen on GAHT with hormone-naive transwomen. 45 50 52 Three studies 16 44 49 used a prospective method gathering data over 12-24 months.…”

Section: Study Designsmentioning

confidence: 99%

“…In non-athletic transgender populations, studies are commonly focused on clinical outcomes, such as bone health. 14 However, studies in non-athletic transwomen undergoing GAHT also report changes in lean body mass (LBM), 15 muscle cross-sectional area (CSA), 16 muscular strength 17 and haemoglobin (Hgb) 18 and/ or haematocrit (HCT). 19 These parameters are of relevance to athletic performance.…”

Section: Introductionmentioning

confidence: 99%

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How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation

et al. 2021

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ObjectivesWe systemically reviewed the literature to assess how long-term testosterone suppressing gender-affirming hormone therapy influenced lean body mass (LBM), muscular area, muscular strength and haemoglobin (Hgb)/haematocrit (HCT).DesignSystematic review.Data sourcesFour databases (BioMed Central, PubMed, Scopus and Web of Science) were searched in April 2020 for papers from 1999 to 2020.Eligibility criteria for selecting studiesEligible studies were those that measured at least one of the variables of interest, included transwomen and were written in English.ResultsTwenty-four studies were identified and reviewed. Transwomen experienced significant decreases in all parameters measured, with different time courses noted. After 4 months of hormone therapy, transwomen have Hgb/HCT levels equivalent to those of cisgender women. After 12 months of hormone therapy, significant decreases in measures of strength, LBM and muscle area are observed. The effects of longer duration therapy (36 months) in eliciting further decrements in these measures are unclear due to paucity of data. Notwithstanding, values for strength, LBM and muscle area in transwomen remain above those of cisgender women, even after 36 months of hormone therapy.ConclusionIn transwomen, hormone therapy rapidly reduces Hgb to levels seen in cisgender women. In contrast, hormone therapy decreases strength, LBM and muscle area, yet values remain above that observed in cisgender women, even after 36 months. These findings suggest that strength may be well preserved in transwomen during the first 3 years of hormone therapy.

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Section: Study Designsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation

et al. 2021

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“…Until further data are available, from a harm minimisation perspective, monitoring haematocrit in transmasculine individuals treated with testosterone is warranted to minimise potential adverse venous and arterial thrombosis risks. Consistent with this, the 2017 Endocrine Society Clinical Practice Guidelines acknowledge a 'very high' risk of polycythaemia in transmasculine individuals and recommends measurement of haematocrit at baseline, every 3 months for the first year and then 1–2 times per year thereafter 23 …”

Section: Discussionmentioning

confidence: 97%

Prevalence of polycythaemia with different formulations of testosterone therapy in transmasculine individuals

Nolan

Leemaqz

Ooi

et al. 2021

Internal Medicine Journal

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Background Masculinising hormone therapy with testosterone is used to align an individual's physical characteristics with his or her gender identity. Testosterone therapy is typically administered via intramuscular or transdermal routes, and polycythaemia is the most common adverse event. Aims To compare the risk of polycythaemia with different formulations of testosterone therapy in transmasculine individuals. Methods A retrospective cross‐sectional analysis was undertaken of transmasculine individuals at a primary and secondary care clinic in Melbourne, Australia. A total of 180 individuals who were on testosterone therapy for >6 months was included. Groups included those receiving: (i) intramuscular testosterone undecanoate (n = 125); (ii) intramuscular testosterone enantate (n = 31); or (iii) transdermal testosterone (n = 24). Outcome was prevalence of polycythaemia (defined as haematocrit > 0.5). Results Mean age was 28.4 (8.8) years, with a median duration of testosterone therapy of 37.7 (24.2) months; 27% were smokers. There was no difference between groups in serum total testosterone concentration measured. While there was no difference between groups in haematocrit, there was a higher proportion of patients with polycythaemia in those who were on intramuscular testosterone enantate (23.3%) than on transdermal testosterone (0%), P = 0.040. There was no statistically significant difference in polycythaemia between intramuscular testosterone undecanoate (15%) and transdermal testosterone, P = 0.066 nor between intramuscular testosterone enantate and undecanoate, P = 0.275. Conclusions One in four individuals treated with intramuscular testosterone enantate and one in six treated with testosterone undecanoate had polycythaemia. No individual treated with transdermal testosterone had polycythaemia. This highlights the importance of regular monitoring of haematocrit in transmasculine individuals treated with testosterone, and findings may inform treatment choices.

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“…Donors who are not on hormonal therapy will have Hb and ferritin levels similar to other donors with the same sex assigned at birth. However, testosterone use will tend to increase Hb levels in trans men, while estrogen will decrease levels in trans women . Blood centers may adopt a pragmatic approach to determining policies for Hb cutoff in trans donors.…”

Section: Determination Of Eligibilitymentioning

confidence: 99%