Abnormal laboratory results are rare in TGD adolescents prescribed GAHT and, if present, occur within 6 months of GAHT initiation, suggesting future guidelines may not require routine screening beyond 6 months in otherwise healthy TGD adolescents.
Key Findings
Results
Hemoglobin and hematocrit decreased in adolescents prescribed estradiol by 6 months after GAHT initiation.
Hemoglobin decreased by -1.4 mg/dL in adolescents prescribed estradiol.
Hematocrit decreased by -3.6% in adolescents prescribed estradiol.
Changes were observed by 6 months after GAHT initiation.
Study included 293 participants, 68% designated female at birth, with no previous history of GnRH analog use.
Results
Hemoglobin and hematocrit increased in adolescents prescribed testosterone by 6 months after GAHT initiation.
Hemoglobin increased by +1.0 mg/dL in adolescents prescribed testosterone.
Hematocrit increased by +3.9% in adolescents prescribed testosterone.
Changes were observed by 6 months after GAHT initiation.
Thirteen participants (6.5%) prescribed testosterone had hematocrit >50% during GAHT.
Results
There were no differences in hemoglobin A1c, alanine transaminase, or aspartate aminotransferase during GAHT.
No significant changes in HbA1c were observed at baseline, 6, 12, or 24 months.
No significant changes in alanine transaminase (ALT) were observed across time points.
No significant changes in aspartate aminotransferase (AST) were observed across time points.
Measurements were abstracted at baseline and at 6, 12, and 24 months after starting GAHT.
Results
There was a small increase in prolactin after 6 months of estradiol therapy in transfeminine adolescents.
The prolactin increase was described as small.
The increase was observed at 6 months after initiation of estradiol therapy.
This finding was specific to transfeminine adolescents receiving estradiol.
Prolactin was among the laboratory measurements abstracted from the medical record at baseline and at 6, 12, and 24 months.
Results
Hyperkalemia in transfeminine adolescents taking spironolactone was infrequent and transient if present.
Potassium levels were monitored at baseline and at 6, 12, and 24 months after starting GAHT.
Hyperkalemia events, when they occurred, were described as transient.
Spironolactone is an antiandrogen frequently used in gender-affirming care of transfeminine adolescents.
Current monitoring guidelines for spironolactone are based on studies in adults or other medical conditions.
Methods
The study recruited TGD adolescents from 4 sites in the United States before beginning GAHT, excluding those with prior GnRH analog use.
293 participants were included in the analysis.
68% of participants were designated female at birth.
Participants were recruited from 4 study sites in the United States.
Participants had no previous history of gonadotropin-releasing hormone analog use.
Laboratory measurements were abstracted at baseline and at 6, 12, and 24 months after starting GAHT.
Background
Current guidelines for monitoring medications used in gender-affirming care of TGD adolescents are based on studies in adults or other medical conditions.
Guidelines do not specifically derive from studies of TGD adolescents.
Commonly screened laboratory measurements investigated included hemoglobin, hematocrit, HbA1c, ALT, AST, prolactin, and potassium.
The authors aimed to investigate these measurements specifically in TGD adolescents receiving GAHT.
Conclusions
The authors concluded that future guidelines may not require routine screening of these laboratory parameters beyond 6 months of GAHT in otherwise healthy TGD adolescents.
Abnormal laboratory results were rare in TGD adolescents prescribed GAHT.
When abnormal results occurred, they were found within 6 months of GAHT initiation.
This conclusion applies specifically to 'otherwise healthy TGD adolescents.'
The finding suggests current routine long-term monitoring protocols may need revision for this population.