Adolescent Gender Affirming Care – Labs Information

Lab Monitoring Information

NOTE: The information has been collected to create a comprehensive guide for individuals and healthcare providers less familiar with these treatment regimens but is NOT intended to be a substitute for medical advice from a doctor or other health care provider familiar

with an individual’s particular case and medical history. Please take these medications as directed by a healthcare provider.



Puberty blockers:

Luteinizing hormone (LH) and estradiol (for people with ovaries) or total testosterone (for people with testicles)

  • Check labs before starting (to confirm puberty has started) The ultrasensitive LH >0.3 mIU/mL is generally considered to be a marker of puberty starting, but this may vary based on the lab methods used. Check the lab reference ranges (what ranges are expected) for the Tanner stage. The Tanner stage is a scale of physical development for puberty.

  • Check labs after 3-6 months on puberty blockers to ensure they are working.

  • Goal levels are: LH < 3 mIU/mL, estradiol < 20 pg/mL, and testosterone < 30 ng/dL)

  • Instead of, or in addition to labs, the physical changes (Tanner stages) can be monitored for signs of puberty. If changes that you do not want are happening, medications can be adjusted.


Menstrual suppression:

No lab monitoring needed


Testosterone:

Labs: Total testosterone (T) and hematocrit

  • Check labs before starting (also called “at baseline”)

  • Check labs 3 months after any dose increase

  • Usually, individuals are aiming for a puberty process where T increases gradually over a few years is the goal:

*Adult range testosterone levels are typically 400-700 ng/dL

  • Hematocrit is a measure of the volume of red blood cells. The expected level is less than 50%. If hematocrit is more than 50%, individuals may need to speak with a clinician (who might ask the individual to consider splitting the dose, making blood donations, or decreasing the dose, but this may need further evaluation)

Estradiol:

Labs: Total testosterone, Estradiol

  • Check labs at baseline

  • Check labs 3 months after any dose increase

  • Usually, you are aiming for a puberty process where estrogen increases gradually over a few years. The goal levels are:

*Adult range estradiol levels are typically 100–200 pg/mL. The goal level for testosterone is usually <50 ng/dL

Spironolactone:

Labs: potassium, BUN, creatinine

  • Check labs at baseline if you have any known kidney, blood pressure, or blood sugar issues.

  • Check labs 3 months after any dose increase that puts your dose over 100 mg daily. If you have any known kidney, blood pressure, or blood sugar issues, check labs with every dose increase.

  • The goal is to have levels in the expected (or reference) range reported by the lab you use.

Bicalutamide:

Labs: AST/ALT

  • Check labs at baseline and every 3 months for the first year. Then every 6-12 months.

  • The goal is to have levels in the expected (or reference) range reported by the lab you use.

References

  1. Seattle Children's. (2023, June). Puberty Blockers. Documents for Patients and Families. https://www.seattlechildrens.org/globalassets/documents/for-patients-and-families/pfe/pe2572.pdf

  2. E. Coleman, A. E. Radix, W. P. Bouman, G. R. Brown, A. L. C. de Vries, M. B. Deutsch, R. Ettner, L. Fraser, M. Goodman, J. Green, A. B. Hancock, T. W. Johnson, D. H. Karasic, G. A. Knudson, S. F. Leibowitz, H. F. L. Meyer-Bahlburg, S. J. Monstrey, J. Motmans, L. Nahata, T. O. Nieder, S. L. Reisner, C. Richards, L. S. Schechter, V. Tangpricha, A. C. Tishelman, M. A. A. Van Trotsenburg, S. Winter, K. Ducheny, N. J. Adams, T. M. Adrián, L. R. Allen, D. Azul, H. Bagga, K. Başar, D. S. Bathory, J. J. Belinky, D. R. Berg, J. U. Berli, R. O. Bluebond-Langner, M.-B. Bouman, M. L. Bowers, P. J. Brassard, J. Byrne, L. Capitán, C. J. Cargill, J. M. Carswell, S. C. Chang, G. Chelvakumar, T. Corneil, K. B. Dalke, G. De Cuypere, E. de Vries, M. Den Heijer, A. H. Devor, C. Dhejne, A. D’Marco, E. K. Edmiston, L. Edwards-Leeper, R. Ehrbar, D. Ehrensaft, J. Eisfeld, E. Elaut, L. Erickson-Schroth, J. L. Feldman, A. D. Fisher, M. M. Garcia, L. Gijs, S. E. Green, B. P. Hall, T. L. D. Hardy, M. S. Irwig, L. A. Jacobs, A. C. Janssen, K. Johnson, D. T. Klink, B. P. C. Kreukels, L. E. Kuper, E. J. Kvach, M. A. Malouf, R. Massey, T. Mazur, C. McLachlan, S. D. Morrison, S. W. Mosser, P. M. Neira, U. Nygren, J. M. Oates, J. Obedin-Maliver, G. Pagkalos, J. Patton, N. Phanuphak, K. Rachlin, T. Reed, G. N. Rider, J. Ristori, S. Robbins-Cherry, S. A. Roberts, K. A. Rodriguez-Wallberg, S. M. Rosenthal, K. Sabir, J. D. Safer, A. I. Scheim, L. J. Seal, T. J. Sehoole, K. Spencer, C. St. Amand, T. D. Steensma, J. F. Strang, G. B. Taylor, K. Tilleman, G. G. T’Sjoen, L. N. Vala, N. M. Van Mello, J. F. Veale, J. A. Vencill, B. Vincent, L. M. Wesp, M. A. West & J. Arcelus (2022) Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, International Journal of Transgender Health, 23:sup1, S1-S259, DOI: 10.1080/26895269.2022.2100644. https://doi.org/10.1080/26895269.2022.2100644

  3. Wylie C Hembree, Peggy T Cohen-Kettenis, Louis Gooren, Sabine E Hannema, Walter J Meyer, M Hassan Murad, Stephen M Rosenthal, Joshua D Safer, Vin Tangpricha, Guy G T’Sjoen, Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 11, 1 November 2017, Pages 3869–3903, https://doi.org/10.1210/jc.2017-01658

  4. Thompson, J, Cavanaugh, T, Hopwood, RA, & Vetters, R. Protocol for the Gender Affirming Care of Transgender, Non-binary, and Gender Diverse Children and Adolescents. April 2019. Fenway Health, Boston. https://fenwayhealth.org/wp-content/uploads/Medical-Care-of-Gender-Diverse-Children-Fenway-Health-Spring-2019-1.pdf

  5. Seattle Children's. (2023, June). Seattle Children’s Gender Clinic Gender-Affirming Hormone Protocols. https://www.seattlechildrens.org/globalassets/documents/clinics/gender/scgc-gah-protocols.pdf