Correspondence: Role of clinical laboratories in reporting results of transgender individuals on hormonal therapy by Phiri-Ramongane and Khine

Phiri-Ramongane and Khine highlight the need for validation of biochemical reference intervals in transgender individuals.1 This is an interesting debate and much has recently been written about shortcomings of laboratory information systems and electronic medical records.2,3 Furthermore, the use of cisgender reference intervals for the transgender community has come under the spotlight over the past few years.3–5 In fact, recent studies have determined reference intervals in the transgender population.3,6 A study on haematological reference intervals in transgender individuals concluded that haematology parameters in transgender men and transgender women receiving stable hormone therapy should be compared with cisgender male and cisgender females reference ranges, respectively.3 Other studies that determined endocrine reference intervals in transgender men and transgender women state that clinicians and laboratories should use appropriate reference intervals to interpret results.6,7 In fact we recently were, to our knowledge, the first in Africa to determine biochemical reference intervals in our local transgender population.8 We found clinically significant differences for sodium, alkaline phosphatase (ALP), gamma-glutamyl transferase and testosterone in transgender men, while transgender women had clinically significant differences in creatinine, albumin, aspartate transaminase, ALP and oestradiol when compared with their cisgender counterparts.8