Transgender FAQs

My patient is transgender and would like their results interpreted against the right reference ranges for them- what do I do? 

Currently, our laboratories default to providing reference ranges according to your patient’s sex assigned at birth because they do not know the stage of their transition or whether they take gender-affirming hormone therapy. We are working on this process to make it as helpful and medically accurate as possible. 

What can I do in the meantime? 

When you order a test, please add additional details in the Notes section for the reporting Doctor.  

You can input your patient’s gender as M>F or F>M and provide extra details about their transition in this section. Please add this information for each test you take, as not all biomarkers are affected in the same way as they transition (research is divided on this). You do not have to share medication details with us, but it can help the doctor to review your patient’s results.  

If appropriate, the doctor will provide comments and advice on their hormone results using a representative reference range for the gender your patient is transitioning to.  

Patient results: 

• If you provide extra information about your patient’s transition, their written report on their hormone markers will reflect their affirmed gender. However, their lab results and reference ranges will be displayed according to their birth sex.  

• Generally, after six months of hormone therapy, their results will fall into the normal range of their affirmed gender.  

• Between zero and six months, there is a grey area where some sex-specific biomarkers and hormones may fall between male and female ranges.  

• Their biological sex can influence a few non-hormone markers, such as their full blood count, liver, and kidney function. Unfortunately, the evidence base on how to interpret these values in transgender patients receiving gender-affirming hormone treatment is limited. Some current guidance (e.g. from NHS Lothian Laboratories March 2020) advises using ranges for the assigned sex at birth for these markers.  

What if your patient is non-binary?  

We recognise that gender is a spectrum, and some people identify as neither male nor female - or somewhere in between.   

Generally, we advise interpreting their results against their sex assigned at birth for the most accurate reflection of their health.   

Some of their results may fall between male and female reference ranges if they take lower-dose masculinising or feminising hormone therapy. In these cases, let our doctors know in their supporting information. 

Research in this area is limited, and interpretation is often on an individual basis.   

Inclusivity is important to us  

In the future, we would like this process to be more streamlined, and we have already made good leaps forward, working with some of our trans customers. Please be assured we are committed to getting it right and giving your patient whatever support they need on their journey.