As soon as someone starts using hormones, it is advisable to keep an eye on a couple of blood values. In fact, hormone treatment causes you to enter puberty, both physically and mentally. The body has to get used to the hormonal shifts – and your mind needs time too.
It is good to realize that everyone is different. That is why cross-sex hormones never have the same effect. Just like with cisgender boys and girls during puberty.
Differences in blood values
As far as blood is concerned, there is little difference between men and women. The normal values (reference values) are almost the same for almost all blood values for all people. So it usually does not matter whether you are male or female, cisgender or transgender.
The only major difference is hemoglobin and hematocrit: (cis and trans) men have slightly higher values for these than (cis and trans) women. Male blood can therefore carry more oxygen than female blood, and is slightly thicker. Sometimes men also have more red blood cells (erythrocytes) than women, but that is not always the case.
Of course, (cis and trans) men and (cis and trans) women have different values for the sex hormones. But that should speak for itself!
In principle, there are no differences in normal values between people with different cultural backgrounds. The living environment in which you live may cause small differences in certain blood values, as can lifestyle and nutrition. That is why reference values can locally deviate slightly from the norm below.
What should you check?
It is advisable to have at least the following provisions checked:
General blood count
Blood cell count, blood cell shape, hematocrit (Ht) and hemoglobin (Hb). Especially Hb and Ht are important. But a blood count machine literally counts everything the lens sees, so you automatically get those other values.Hormones
Follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen (estradiol), progesterone, prolactin, sex hormone-binding globulin (SHBG) and testosterone. Especially during the first two years of hormone use, it is important to check both male and female hormone levels. After that, you can basically get by with just the hormone levels that correspond to what you are using.Liver and kidney values
Alanine aminotransferase (ALT), aspartate aminotransferase (AST), cholesterol (HDL, LDL and total), CKD-EPI-GFR, glucose, creatinine, MDRD-GFR and triglycerides.Other
Many GPs and endocrinologists also check vitamin B12, vitamin D3 and the thyroid hormones thyroid-stimulating hormone (TSH) and T4.
In addition, it is important to have your blood pressure measured. Especially at the beginning of your hormone treatment, a lot changes in your body. If your blood pressure deviates, this can be treated in the usual way. In this, trans people are no different from cis people.
How often should you check?
Especially during the first year of hormone use, it is important to have the above-mentioned determinations done every three months. After that, the body is largely stabilized and testing about once a year is sufficient.
If you have to pay for these blood tests yourself for whatever reason, it is advisable to at least have the values of Hb, Ht, LDL cholesterol, triglycerides, cross-sex hormone and for trans women also the testosterone inhibitors measured.
For those who use hormones in pill form, it is also important to have the liver values checked. The dose of hormones in hormone treatment is so high that it is stressful for the liver. (An endocrinologist will therefore always first recommend other forms of administration, such as gel, injection or patches. These are not absorbed via the digestive tract and are therefore much less stressful for the liver. But in some cases, pills are simply the only option.)
Thyroid
The thyroid gland is the conductor of our hormonal (endocrinological) orchestra: it regulates the speed of these processes. As soon as trans people go into hormonal transition, quite a lot changes! Due to the decrease in your own sex hormones, you enter menopause or penopause, as it were. Then you go straight to (cross-sex) puberty. That means hormonal chaos! That is why it is advisable to have your thyroid checked, especially the first two years that you use hormones.
In any case, it can do no harm for everyone from the age of 35 to have their thyroid values checked occasionally. A disordered thyroid gland has a major impact on your physical and mental well-being.
What does the result mean?
As mentioned above: there is little difference between men and women in terms of blood. The normal values are the same for almost all blood values for (cis and trans) men and (cis and trans) women.
It is good to realize that the computer automatically compares your blood values with the normal values of your legal gender. That is the gender with which you are registered in the Personal Records Database (BRP).
For example, if you are (still) registered as a woman and use testosterone, the computer will compare your Hb values with the normal values for women. Suppose your Hb value is 10.8, the computer will mark it as much too high. While that value is perfectly fine for you as a trans man!
Please note: Correctly interpreting deviations from normal values is a profession. (This is the domain of clinical chemistry.) Your entire medical situation is important for this, from age to lifestyle, from family disorders to complicated endocrinology. General practitioners generally know too little about this and should refer every patient with abnormal blood values to an endocrinologist or internist.
Reference values
Below you will find an overview of the blood tests that are recommended to be performed once a year. For each blood test you will find a short description and the normal values for (cis and trans) women and (cis and trans) men.
| Determination | Description | Women | Men |
|---|---|---|---|
| Alanine transaminase (ALT), or Alanine aminotransferase (ALAT) | This enzyme (protein) converts substance A into substance B. It is found in various cells, but mainly in the liver. That is why ALAT is good for measuring liver function, especially when there is a suspicion of liver damage or liver disease. (Usually tested together with AST.) | < 40 U/l | < 50 U/l |
| Aspartate transaminase (AST), or Aspartate aminotransferase (ASAT) | This enzyme (protein) is found in many cells, where it converts substance C into substance D, and vice versa. When a cell breaks down, ASAT is released into the bloodstream and can be measured. This test shows the degree of liver damage. (Usually tested together with ALT.) When using hormones, it is good to check liver function. | < 35 U/l | < 45 U/l |
| Cholesterol | Cholesterol is a fatty substance, which is made in the liver. There are 2 types of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). HDL is the good cholesterol that maintains your blood vessels. LDL is the building block for sex hormones, but is bad for your blood vessels. Tested together with triglycerides as a ‘lipid profile’ (fat ratio) of the blood. | HDL: 1,04-1,55 mmol/l LDL: 0,9-3,5 mmol/l Total: < 5 mmol/l | idem |
| CKR/EPI/GFR | Tests estimated kidney function, based on average muscle build, height, weight, gender and age. | Ca. 60 ml/min/1,73 m2 | idem |
| Follicle-stimulating hormone (FSH) | This hormone regulates egg maturation and the production of estrogen. In men, it regulates the production of sperm. It is produced in the pituitary gland. | 1-10 E/l | idem |
| Glucose | Blood sugars | Fasting: 4,5-8 mmol/l 2 hours after eating: < 9 mmol/l | idem |
| Hematocrit (Ht) | The ratio of blood fluid to blood cells. | 0,36-0,47 l/l | 0,41-0,50 l/l |
| Hemoglobin (Hb) | Protein in red blood cells that carries oxygen. | 7,5-10 mmol/l | 8,5-11 mmol/l |
| Creatinine | Muscle breakdown product that the kidneys excrete. This tests how much waste is in the blood and therefore how much the kidneys filter per minute. | < 106 μmol/l | < 124 μmol/l |
| Luteinizing hormone (LH) | This hormone triggers ovulation and also influences testosterone production in men and women. It is produced in the pituitary gland. | 5-100 E/l | 5-15 E/l |
| MDRD-GFR | Tests the kidneys’ filtering speed, including the creatine level. Creatine is an indicator of muscle strength and energy consumption in the muscles. The creatine level reflects the functioning of the kidneys. When using hormones, it is good to check the kidney function. | Ca. 100 ml/min | idem |
| Estrogen | This hormone makes women sexually mature and also ensures bone formation and our vascular and nervous systems. The most important source is the ovaries. The adrenal glands (at the top of the kidneys) and fatty tissue also produce small amounts. | 40 tot 1.380 pmol/l (depending on moment in the cycle) Gender clinics often use: 367 tot 734 pmol/l | 40 tot 130 pmol/l Postmenopausal women have the same values as men. |
| Progesterone | This hormone regulates, among other things, the growth of the uterine lining. | < 60 nmol/l | < 1-3 nmol/l |
| Prolactin | This ensures milk production and inhibits ovulation. | < 22 μg/l | 0,15 μg/l |
| Sex hormone-binding globulin (SHBG) | This binds to testosterone in men and to estrogen in women. It indicates how much testosterone or estrogen is used in the body. | Depending on age: the older, the higher | idem |
| T4 | T4 is a thyroid hormone that stimulates metabolism (and therefore body growth), and also increases body temperature and blood flow. This test measures the function of the thyroid gland. | 9-24 pmol/l | idem |
| Testosterone | This hormone turns men sexually mature and also ensures muscle and bone building. | 0-4 nmol/l | 11-35 nmol/l |
| Thyroid-stimulating hormone (TSH) | TSH regulates the speed of the thyroid gland. This test measures the function of the thyroid gland. | 0,3-5,0 mE/l | idem |
| Triglycerides | The blood transports these fats for the muscles. Tested together with cholesterol as a ‘lipid profile’ (fat ratio) of the blood. | < 1,7 mmol/l | idem |
| Vitamin B12 | Vitamin B12 has a great influence on mood and bodily functions. Nowadays you quickly come up short on B12. That is why it can do no harm to supplement it. | 150-700 pmol/L | idem |
| Vitamin D3 | Vitamin D3 is mostly produced by sunlight, and we therefore quickly become deficient. That is why it is not a bad idea to supplement it. Note: most GPs maintain a lower normal value, which maintains a deficiency. | > 75 nmol/L (There is no upper limit) | idem |
This information has been compiled by N.L. Harsveld, clinical chemist.
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