Table 2.
Impact of gender-affirming hormones on selected analytes from published studies.
| Analyte | Estradiol1 | Testosterone2 | Most Likely Clinical Impact3 |
|---|---|---|---|
| Alkaline phosphatase | No change (or minimal decrease) | Increase | Testosterone may shift values slightly above cisgender female RI |
| Alanine aminotransferase | No change (or minimal decrease) | Increase | Testosterone may shift values slightly above cisgender female RI |
| Aspartate aminotransferase | No change (or minimal decrease) | Increase | Testosterone may shift values slightly above cisgender female RI |
| Creatinine | No change (or minimal decrease) | Increase | Choice of sex will impact eGFR and potentially category of chronic kidney disease |
| Hemoglobin/hematocrit | Decrease | Increase | Decrease due to estradiol may be misinterpreted as anemia; increase due to testosterone may be misinterpreted as erythrocytosis |
| High-density lipoprotein | Variable (no change or increase) | Decrease | Testosterone may shift values below cisgender female RI |
1Estradiol gender-affirming therapy shifts reference interval for hemoglobin and hematocrit to lower values, aligning with cisgender female reference intervals. For the other four tests, estradiol has minimal effect, either slight decrease or no change depending on published study.
2In general for these five laboratory tests, testosterone gender-affirming therapy shifts reference interval to higher values, aligning with cisgender male reference intervals.