Liver function in transgender persons: Challenges in the COVID-19 era

Table 1 Timeline for monitoring trans men

Laboratory evaluation
Baseline blood tests	Testosterone, estradiol; CBC (including Hct or Hgb); Liver enzymes, lipid profile, creatinine; Fasting glucose (and HbA1c or oral glucose tolerance test if diabetes is suspected)
4-6 wk after starting treatment	Testosterone, estradiol; CBC (including Hct or Hgb)
3, 6, 9, and 12 mo after starting treatment	Testosterone, estradiol; CBC (including Hct or Hgb); Liver enzymes, lipid profile, creatinine (every 6 mo); Fasting glucose (every 6 mo)
Semiannually or annually thereafter	Testosterone, estradiol; CBC (including Hct or Hgb); Liver enzymes, lipid profile, creatinineFasting glucose (every 6 mo)
In 50 yr of age (only if treatment is stopped or when risk factors for osteoporosis exist) and accordingly thereafter	Bone mineral density measurement
Individualized approach	Screening tests for breast and endometrial cancer (with no prior hysterectomy)
Clinical assessment
Regular clinical examination (including body weight and blood pressure measurements), evaluation of masculinization, recording and monitoring of potential side effects

CBC: Complete blood count; Hct: Hematocrit; Hgb: Hemoglobin; HbA1c: Glycated hemoglobin.

Table 2 Timeline for monitoring trans women

Laboratory evaluation
Baseline blood tests	Testosterone, estradiol; Prolactin; CBC; Liver enzymes, lipid profile, creatinine; Fasting glucose (and HbA1c or oral glucose tolerance test if diabetes is suspected); Electrolytes; Coagulation tests (in case of high risk for thrombosis)
1 mo after starting treatment	CBC; Liver enzymes, lipid profile, creatinine; Electrolytes (if taking spironolactone)
3, 6, 9, and 12 mo after starting treatment	Testosterone, estradiol; CBC; Liver enzymes, lipid profile, creatinine (every 6 mo); Fasting glucose (every 6 mo); Electrolytes (if taking spironolactone)
Semiannually or annually thereafter	Testosterone, estradiol; Prolactin (every 2 yr); CBC; Liver enzymes, lipid profile, creatinine; Fasting glucose (every 6 mo); Electrolytes (if taking spironolactone)
In 60 yr of age (or earlier if treatment is stopped after orchiectomy or when risk factors for osteoporosis exist) and accordingly thereafter	Bone mineral density measurement
Individualized approach	Screening tests for prostate and breast cancer
Clinical assessment
Regular clinical examination (including body weight and blood pressure measurements), evaluation of feminization, recording and monitoring of potential side effects

CBC: Complete blood count; Hct: Hematocrit; Hgb: Hemoglobin; HbA1c: Glycated hemoglobin.