Department of Pharmacy, School of Health Sciences, Mayo Clinic, Rochester, MN.
Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT.
Am J Health Syst Pharm. 2020 Mar 5;77(6):427-433. doi: 10.1093/ajhp/zxz355.
Transgender patients face considerable healthcare disparities. Improved means of recognizing transgender patients and understanding their medical needs is important to provide optimal care. The electronic medical record (EMR) of our health system allows for differentiation of gender identity, legal sex, and sex at birth. With EMR recognition of transgender patients, a recommendation for estimating creatinine clearance (CLcr) and ideal body weight (IBW) was needed to standardize medication dosing.
The literature was reviewed for evidence on the effect of gender-affirming hormone therapy on serum creatinine concentration and lean body mass. Findings informed a recommendation for drug dosing based on CLcr and IBW in transgender patients. Four studies that reported the effect of hormone therapy on biometric laboratory values were found. Three studies reported that values of transgender patients more closely resembled the standard values of their gender identity vs sex at birth after hormone therapy; 1 study reported a range of values that more closely resembled those associated with sex at birth while still overlapping with values associated with gender identity. Consequently, it was recommended that pharmacists dose medications based on CLcr and IBW calculations consistent with gender identity after a patient has been on hormone therapy for 6 months or longer.
Providing optimal care to transgender patients includes considering the effect of gender-affirming hormone therapy on overall physiology. Consistently using the appropriate CLcr and IBW calculations for each patient ensures safe and effective care. Additional studies are needed to confirm the effect of hormone therapy on renal clearance and lean body mass.
跨性别患者面临着相当大的医疗保健差距。提高识别跨性别患者和了解其医疗需求的能力对于提供最佳护理至关重要。我们的健康系统的电子病历（EMR）允许区分性别认同、法定性别和出生时的性别。通过 EMR 识别跨性别患者，需要对估计肌酐清除率（CLcr）和理想体重（IBW）进行推荐，以标准化药物剂量。
对性别肯定激素治疗对血清肌酐浓度和瘦体重的影响进行了文献综述。研究结果为跨性别患者基于 CLcr 和 IBW 的药物剂量推荐提供了信息。发现了四项报告激素治疗对生物计量实验室值影响的研究。三项研究报告称，接受激素治疗后，跨性别患者的数值更接近其性别认同的标准值，而不是其出生时的性别；一项研究报告了一个更接近与出生时性别相关的值的范围，同时仍与性别认同相关的值重叠。因此，建议药剂师在患者接受激素治疗 6 个月或更长时间后，根据 CLcr 和 IBW 计算值，按照性别认同为患者进行药物剂量。
为跨性别患者提供最佳护理包括考虑性别肯定激素治疗对整体生理的影响。为每个患者始终如一地使用适当的 CLcr 和 IBW 计算值可确保安全有效的护理。需要进一步的研究来确认激素治疗对肾清除率和瘦体重的影响。
