Abstract
Objectives This study aimed to highlight the necessity of developing and implementing appropriate
reference ranges for transgender and nonbinary (TGNB) patient populations to minimize
misinterpretation of laboratory results and ensure equitable health care.
Case Report We describe a situation where a TGNB patient's abnormal laboratory values were not
flagged due to undefined reference ranges for gender “X” in the Laboratory Information
System (LIS). Implementation of additional reference ranges mapped to sex label “X”
showed significant improvement in flagging abnormal lab results, utilizing sex-invariant
reporting as an interim solution while monitoring developments on TGNB-specific reference
ranges.
Conclusion Informatics professionals should assess their institution's policies for registration
and lab reporting on TGNB patients as nonimplementation poses significant patient
safety risks. Best practices include using TGNB-specific reference ranges emerging
in the literature, reporting both male and female reference ranges for clinical interpretation
and sex-invariant reporting.
Keywords
transgender health - nonbinary - laboratory reference ranges - electronic health records
- clinical informatics
