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Critical Values is the go-to resource for the entire laboratory team, providing insight and information on the latest research, information, and issues within pathology and laboratory medicine. The print and online magazine invites submissions on topics including, but not limited to, advocacy, education, technology, global health, workforce, workplace best practices, and leadership.
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Our Recent Articles
Gender Affirming Care and The Lab
The laboratory touches every patient in a healthcare setting, even if pathologists and some laboratory professionals don’t have direct patient contact. Understanding the needs of different patient populations is critical to providing high-quality care.
Though there have been significant strides in gender-affirming care for transgender and gender non-conforming patients, there are still barriers that pathologists and laboratory professionals can help break down.
These efforts are crucial at a time when several states are trying to pass bans on gender-affirming care for minors and even adults. In Texas, Senate Bill 14,1 which bans all gender affirming care and surgeries to minors, passed the state senate and awaits Governor Abbott’s signature to become law. These setbacks make the laboratory’s role in gender affirming care even more important.
Jeffrey SoRelle, MD, based in Dallas, Texas, is alarmed by these steps backward in gender affirming care, as part of what he calls “policies that are controlling people’s healthcare decisions.”
“I know specific physicians who used to run gender affirming clinics in the children's hospital that have had to leave practice in Texas specifically. That's horrible,” he says.
While states battle this kind of legislation, there are things that laboratory professionals and pathologists can do to provide the best possible care to these patients.
The electronic medical record as a barrier
Electronic medical records [EMRs] are still a barrier for transgender and gender non-conforming patients, according to Robin LeGallo, MD, though they can be customized to accept preferred names and pronouns. It just has to be made a priority.
“At least in our hospital our electronic medical record is not uniform. Some patients who are transgender may never even tell the medical center that they are,” she says.
It begs the question, when does the pathologist or laboratory professional need to know that a patient is not the gender they were assigned at birth, Dr. LeGallo says. “That becomes very challenging. You can't adjust laboratory values if you don't know the individual patient,” Dr. LeGallo said. “Just knowing what the patient's status is, if they're on hormonal therapy, will change [values].”
EMRs can be modified, however, to include fields such as sex assigned at birth and gender, or even legal sex, potentially all three of those, Dr. SoRelle says. It’s just a matter of healthcare professionals taking the initiative to drive these changes.
Be aware of differing lab values
Laboratory professionals and pathologists can support gender affirming care with awareness that flags on lab values can often hint at the patient being transgender.
“A common situation for transgender people to face is when their lab values aren't matching their sex assigned at birth because they're on hormone therapy, so it produces a whole bunch of flags,” Dr. SoRelle says.
When this happens, he suggests, “Just dig into it deeper. I first got introduced to this when there was a male patient with a very high estradiol level and I had a concern for cancer. It was actually a transgender person who was just taking extra amounts of their medication.”
Creating new laboratory value standard ranges for transgender and gender nonconforming folks is a work in progress in laboratory medicine, but it isn’t quite there yet.
“There are good studies out now that show the hematology reference ranges for a transgender man on testosterone can be changed to the cisgender male ranges and vice versa for transgender females on estrogen therapy,” Dr. SoRelle points out.
Ultimately, to get a more comprehensive look at all the different laboratory values, how they may be changed, transgender people need their own personalized medicine, Dr. SoRelle says.
Improve education and communication
Education is also important across the board, for all the healthcare professionals who interact with transgender and gender nonconforming patients, from primary care physicians to specialists, Dr. LeGallo stresses.
Laboratory directors and pathologists can take a hand in leading the charge in bringing about necessary education.
Dr. SoRelle cited UCSF’s Transgender Care website2 as a great starting point for education. Their guidelines encourage such practices as:
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Cultural humility: Learn not to project your own experiences or identities onto others and approaching patients as individuals with no preconceptions.
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Training all frontline staff: Anyone who interacts with patients should receive training on gender-affirming practices and healthcare needs.
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Terminology fluency: Staff should be trained on common terminology used by the trans community.
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Collect gender identity data. Any intake forms or online portals should include a chosen name and pronouns, current gender identity, and sex listed on original birth certificate.
While many laboratory professionals, and even pathologists, may not interact directly with patients, for those that do, such as phlebotomists, Dr. SoRelle says, “It’s important for staff to have good cultural competency such that they call patients by their preferred names.”
There are even workarounds beyond calling out a legal name, such as a date of birth, or other identifying details. “This makes patients feel more seen and that people are caring about them as a person,” he says.
Display your pronouns
Perhaps the simplest thing that any laboratory professional or pathologist can do to support gender affirming care is to prominently display your own pronouns, whether this is on a badge at work, in your email signature, and anywhere else that patients might see.
“It just goes back to not hiding it,” Dr. LeGallo says. “Hopefully there's a day that we don't need to put our pronouns on our buttons, but we still do now because we're trying to show that we are affirming as much as anything.”
Set safe hours
Since some transgender individuals may not feel comfortable in a traditional clinic or hospital setting, Dr. SoRelle has seen clinics that will specifically tailor time periods to that population.
“In a few of the cases where we did research, [clinics] had Tuesday afternoons or Thursday afternoons specifically for transgender care, and people would feel comfortable coming to see other people that are there for the same reason and not feel excluded,” he says.
Mentor younger laboratory professionals
Dr. LeGallo also makes a point of mentoring younger medical students, as well, seeing it as an opportunity to expand awareness and empathy for transgender and gender nonconforming patients, among other things.
“We don't have to just practice within the confines of our laboratories. We can have a seat at the table in many different places,” she says.