ADLM publishes first comprehensive U.S. guidance to help laboratory medicine professionals meet the needs of gender diverse patients

WASHINGTON, July 1, 2026 /PRNewswire/ -- The Association for Diagnostics & Laboratory Medicine (ADLM) has released the first extensive U.S. guidance to help laboratory medicine professionals navigate the unique challenges of caring for gender-diverse patients. The recommendations provide a framework for interpreting lab results affected by gender-affirming hormone therapy, improving electronic health record practices, and supporting more accurate, equitable, and patient-centered care.

Read the guidance document: https://myadlm.org/science-and-research/academy-guidance/gender-diversity

As gender-affirming care becomes more common, laboratory professionals face growing questions about how to accurately interpret test results for gender-diverse patients. Gender-affirming hormone therapy can alter the results of certain common laboratory tests, including several used for cardiac, kidney, and liver health. This can make it difficult to determine whether a test result indicates a medical issue or not.

Further complicating matters, electronic health record systems often lack the flexibility to capture information relevant to gender-diverse patients, such as gender identity, sex assigned at birth, and organ inventories. This can affect screening reminders, causing patients to miss out on screenings that remain relevant based on the organs that they have, such as cervical cancer screenings for transgender men.

Limitations with other laboratory and pathology systems and practices can also lead to gaps in equitable care in areas ranging from transfusion medicine to autopsy reporting.

Although several U.S. medical societies have published recommendations for the care of gender-diverse patients over the past 15 years, including guidance from endocrinology, pediatrics, plastic surgery, and urology organizations, none have broadly covered the specific challenges facing laboratory medicine and pathology. To fill this gap, ADLM convened a group of clinical chemists, pathologists, endocrinologists, and clinicians who directly care for transgender patients to develop this new guidance.

The ADLM guidance document primarily focuses on adults who have been receiving gender-affirming hormone therapy for at least 6 months, as this is the area where the strongest evidence currently exists. Major recommendations from the document include the following:

• Clinicians should move beyond a one-size-fits-all approach to reference intervals — which are critical for interpreting lab test results — and instead take a holistic approach to patient care, looking at physiology, hormones, and how the patient feels. For example, although societies have recommended 100–200 pg/mL as the target concentration for estradiol for transgender women, published data support a wider range, assessed in the context of patient-personalized goals and other factors.
• An organ inventory should be included in a patient's electronic health record. It would take the form of a table or checklist that documents the presence or absence of specific organs and dates of surgical procedures and allow for more precise interpretation of lab results and preventive screening decisions.
• Transfusion medicine practices involving transgender and nonbinary donors and recipients would benefit from standardized, evidence-based approaches to maintain safety and equity.
• Autopsy reports should document both legal sex and affirmed gender identity, use the decedent's chosen name and correct pronouns, describe anatomical findings in gender-neutral terms, and note evidence of gender-affirming care without speculation.

"The interpretation of laboratory and pathology tests for gender-diverse patients remains an evolving area of medicine," wrote the document authors Drs. Tiffany A. Thomas, Gabrielle N. Winston-McPherson, Ina Amarillo, Alisha D. Berry, Caroline J. Davidge-Pitts, Sridevi Devaraj, Zil Goldstein, Brad S. Karon, Brooke M. Katzman, Mahmoud A. Khalifa, Hung S. Luu, James H. Nichols, Tracy L. Stockley, Michelle R. Stoffel, Dina N. Greene, and Matthew D. Krasowski. "As the evidence base continues to grow, laboratories, healthcare organizations, and researchers must work together to develop patient-centered approaches that support accurate test interpretation, respectful documentation, and equitable care."

About the Association for Diagnostics & Laboratory Medicine (ADLM)
Dedicated to achieving better health for all through laboratory medicine, ADLM unites more than 70,000 clinical laboratory professionals, physicians, research scientists, and business leaders from 110 countries around the world. Our community is at the forefront of laboratory medicine's diverse subdisciplines, including clinical chemistry, molecular diagnostics, mass spectrometry, clinical microbiology, and data science, and is comprised of individuals holding the spectrum of lab-related professional degrees, certifications, and credentials. Since 1948, ADLM has championed the advancement of laboratory medicine by fostering scientific collaboration, knowledge sharing, and the development of innovative solutions that enhance health outcomes. For more information, visit www.myadlm.org.

Christine DeLong
ADLM
Director, Editorial and Media Relations
(p) 202.835.8722
[email protected]

Bill Malone
ADLM
Senior Director, Strategic Communications
(p) 202.835.8756
[email protected]

SOURCE Association for Diagnostics & Laboratory Medicine (ADLM)