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Understanding Raised Hematocrit in Gender-Affirming Care

Gender-affirming care, which encompasses medical interventions aimed at aligning an individual’s physical characteristics with their gender identity, plays a crucial role in supporting the health and wellbeing of transgender and gender-diverse individuals. Hormone replacement therapy (HRT) is a cornerstone of gender-affirming care, commonly used to induce feminization or masculinization in accordance with an individual’s gender identity. However, many people are warned off it if their red blood cells are fatter than usual – their haematocrit is high. Is this correct though?

Understanding Hematocrit and Its Significance:
Hematocrit refers to the proportion of red blood cells in the blood, expressed as a percentage of the total blood volume. It is a crucial parameter in assessing blood health and oxygen-carrying capacity. Elevated hematocrit levels, known as polycythemia, can occur due to various factors, including dehydration, smoking, high altitude, and certain medical conditions. In the context of hormone therapy, testosterone administration has been associated with an increase in hematocrit levels. Markedly raised levels can potentially lead to complications such as polycythemia, thrombosis (blood clots), and cardiovascular events, so people naturally worry.

The Impact of Testosterone Therapy on Hematocrit:
Testosterone is administered as part of masculinizing hormone therapy for transgender men and non-binary individuals. While testosterone therapy is effective in inducing masculinization, it can also stimulate the production of red blood cells, leading to an increase in hematocrit levels. This phenomenon, known as erythrocytosis or polycythemia, is a well-documented side effect of testosterone therapy and requires careful monitoring to mitigate potential health risks.

Health Monitoring and Management Strategies:
Given the potential risks associated with elevated hematocrit levels, individuals undergoing testosterone therapy should undergo regular health monitoring. This may include periodic blood tests to assess hematocrit levels, blood pressure monitoring, and evaluation for signs of cardiovascular disease. Healthcare providers should be vigilant in detecting and managing hematocrit-related complications, which may necessitate adjustments to hormone dosages or interventions to reduce hematocrit levels.

Principles of Gender-Affirming Care:
In providing gender-affirming care, it is essential to uphold principles of equity, respect, and patient-centeredness. While hematocrit-related concerns may arise in the context of hormone therapy, they should not detract from the provision of compassionate and affirming care. Healthcare providers must engage in open and respectful communication with transgender and gender-diverse individuals, ensuring that they are informed about the potential risks and benefits of hormone therapy and involved in decision-making regarding their healthcare. At the end of the day, individuals should be encouraged to make their own decisions and weight up the risks and benefits.

Transgender Healthcare Guidelines and Best Practices:
Medical organizations and healthcare providers often adhere to guidelines and protocols specific to transgender healthcare to ensure the provision of safe and effective care. These guidelines may include recommendations for hormone therapy initiation, monitoring of hematocrit levels, and management of hematocrit-related complications. By following evidence-based practices and staying abreast of emerging research, healthcare providers can deliver high-quality gender-affirming care while minimizing risks to patient health.

What about Estrogen?

Individuals assigned female at birth who have elevated hematocrit levels are not typically advised to cease estrogen therapy. Just as with testosterone therapy, high hematocrit levels should not automatically preclude the initiation or continuation of estrogen hormone therapy. In clinical practice, individuals with ovaries who exhibit high hematocrit levels are not routinely instructed to discontinue estrogen therapy. Instead, healthcare providers may opt for close monitoring and targeted interventions to address any potential risks associated with elevated hematocrit levels. By reframing the conversation surrounding hematocrit management, healthcare providers can ensure that transgender and gender-diverse individuals receive equitable access to hormone therapy while minimizing unnecessary barriers to care.

Raised hematocrit levels represent a notable consideration in the context of hormone therapy for transgender and gender-diverse individuals. While testosterone therapy may lead to increases in hematocrit levels, comprehensive health monitoring and management strategies can help mitigate potential risks and ensure the provision of safe and affirming care. By prioritizing patient-centered approaches, adherence to clinical guidelines, and ongoing education, healthcare providers can support the health and well-being of transgender and gender-diverse individuals on their gender-affirming journey.

Updated on February 21, 2024

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