How should laboratories plan to provide services to and perform lab testing for transgender patients? Dina Greene, PhD, DABCC, will explore such issues in an AACC webinar on Oct. 27 titled “When Gender Doesn't Equal Sex: What to Consider When Testing Transgender Patients”.

There’s a general assumption that the sex an individual is assigned at birth is the person’s gender identity, but that belief is changing, explained Greene, an assistant professor of laboratory medicine at University of Washington. “What we know is that’s not the case, as transgender individuals become more socially acceptable and there’s more social awareness around this,” she told CLN Stat. Despite these advancements, the transgender population is an often-underserved population within the medical community.

Systemic, social and physiological barriers impede giving proper medical care to this population, Greene said. Electronic medical record systems generally don’t recognize transgender patients. “It is a binary system most of the time—there’s no room for anything but male or female. Additionally, most of the transgender population doesn’t want to be ‘othered.’ They do have a gender, the gender they identify with, even if you don’t agree.”

For the lab, challenges exist on several fronts, Greene continued. Part of the phlebotomist’s job, for instance, is to make sure that the identity on a tube matches the patient’s identify. “If they’re drawing a sample on a person whose tube is labeled male, and that person doesn’t identify as a male, it’s a very awkward thing.”

There may be instances in which a person who identifies as female needs a tissue biopsy following a prostate screening. Or, a pregnancy test is ordered for a patient who identifies as male. How does a lab handle these cases? “I know some systems would completely reject that sample as a misorder,” Greene said.

Then there’s the physiological component, as far as what comprises a normal laboratory result for a transgender patient. “In general, we often have ‘sex assigned at birth’ reference ranges for many different laboratory tests like liver enzymes or estimated glomerular filtration rate, or when you’re just analyzing someone’s basic hematologic parameters,” Greene observed.

For transgender patients, this brings up specific considerations for labs. For example, knowing whether a transgender patient has been on hormone therapy, and at what point the lab should switch to the other sex or reference intervals in analyzing samples from a transgender person. “For kidney disease or other things that might have sex-specific reference ranges, which ones are more appropriate?” Greene noted.

The webinar’s main objective is to educate laboratorians on what it means to be transgender, how this is a very diverse population and some of the things that impact their medical care, she said.

“I’m not going to be able to solve all of these problems. But hopefully the folks that listen in will understand the differences between sex and gender, because I don’t think that’s very well understood—and begin to appreciate the barriers that binary systems sets up for the transgender population.”

Register online to attend this very important and timely webinar, “When Gender Doesn't Equal Sex: What to Consider When Testing Transgender Patients.”