In our free introductory visits, we often state that we’ll talk about what labs we might want to order at your first medical visit. At QueerDoc, informed consent is foundational, and we want to discuss all of your options for your care, including lab work.
These are the labs for adult care that our patients at QueerDoc are most often interested in. Some young and otherwise healthy patients may decide not to pursue baseline labs before initiating care, and that’s cool. When thinking about that decision, we’ll talk about the possible risks involved in not getting baseline labs done and what might happen if any concerning results appear on future labs.
What Happens if Your Lab Results Are Flagged?
First off, taking a few deep breaths can help your nervous system settle. There are several reasons why lab results may come back as high, low, or concerning, and they don’t necessarily mean that something is wrong. Consider the scenarios below, then reach out to your prescriber for more information and next steps.
Know that you may be seeing your lab results before your clinician does.
1. Expectation Mismatches
An expectation mismatch is a lab result that is different from what we expected or what the lab system expects. The most common reason for this is that the systems in place aren’t designed to recognize gender care and may expect a different result than the care goal.
Scenario: Lab software generally doesn’t get nuance. It does have a set of instructions to flag a result as high or low according to various criteria. In transgender medical care, we may see results come back flagged as High or Low according to blood levels of hormones expected for the gender or sex marker available in the software, not the therapeutic ranges we’re going for in gender care. Have ovaries and take T? Your T may be higher than the software expects. Have testicles and take E? Your T and E levels may be different than what the software expects, but it is expected by you and your provider. Your provider might say your labs are appropriate for your goals of care.
2. Preparation Errors
A common error that can result in unexpectedly high lab results is errors in preparation: something was done before blood was drawn to skew the results. The most common? Hormones on the skin!
Scenarios: It isn’t uncommon for hormones to get on the skin. We often want this: transdermal preparations of hormones like patches and gels are designed to go on the skin! But, it’s also easy to get injectable hormones on the skin. If the place where your blood draw happens also has some hormones or other medications on top of the skin at the time of the blood draw, some of that extra goodness may transfer onto the needle and then into the vial and be counted in your lab result.
How Can You Prevent This?
If you can, get your blood draw from another part of your body than from where your hormone applications go. Also, especially if you are a gel or patch user, rinse off well before a blood draw.
3. Timing Whoopsies
All of the forms of hormones that we have at our disposal have different half-lives. A half-life is the time at which half of the chemical is expected to have been processed by your body. Although everybody’s body is different, we can expect your blood levels of a medication to rise shortly after it is taken and then gradually decrease as your body uses that medication. Most medications have a known timeline that we can predict, but a lot can happen. The levels of hormones in your bloodstream are not constant, and can change over time, especially if you’re doing injections once a week.
If you’ve gotten your blood draw immediately after an injection, or shortly before your next one is due, your lab results are probably going to be higher or lower than expected. In practice, we know that hormone levels can shift dramatically in the body. We like seeing the snapshots in time that lab results can provide, but we also want to know about your whole movie reel of how you feel over time.
4. Draw Errors
Phlebotomists, and nurses, and clinicians, OH MY! It may seem like the person who is drawing your blood has done this a million times and it is all routine. It may be all routine, but occasional errors may still happen.
Did you know that sample vials have color-coded tops? Check out UNC’s phlebotomy services page for an overview! And that vials are often coated with or contain substances specific to which test is intended? AND if more than one vial of blood is being drawn, it matters which order the vials are in? AND that it matters how much blood gets drawn into which type of vial?
The wrong tube, the wrong order, or the wrong amount can skew your results.
The skill of your provider is also a factor. Red blood cells are fragile little beasts. If storage temperature is off, or the vacuum seal on the tube isn’t quite right, or is changed during the blood draw, the red blood cells in your sample may get damaged. This is called hemolysis, and may cause your labs to be inaccurate or refused. It’s the number one reason why samples get rejected and blood draws need to be redone. It matters especially for labs like ALT and AST (to measure your liver enzymes,) and red blood cell counts, hemoglobin, and hematocrit counts, which are part of a complete blood panel, and labs we frequently order.
5. Processing Errors
Running lab tests are often complex and involve manipulating the sample. This may be physical manipulation like spinning the vial in a centrifuge, and it can be chemical manipulation by adding another compound to the sample and looking for reactions. Some labs are read by the technician, and some are read by a machine. There are a lot of moving parts and any one of those can have an error happen. Machines may need to be calibrated. Chemicals may need to be replaced. A fridge or freezer could fail, thus damaging the sample by an out of whack temperature.
How To Navigate All Of This?
Before Your Labs:
- Ask your provider about what the expected results for your labs are, and what it might mean if they come back low, high, or otherwise not-as-expected.
- Double-check your timing. When does your provider wants you to get your labs done?
- Try to make sure that your draw site is free of possible contaminants.
- Sufficient hydration in your body can make it easier for you and your technician.
If Labs Come Back Flagged:
- Know that sometimes, labs just need to be re-done.
- Know that it may not mean that something is amiss.
- Reach out to your provider for information and next steps.
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