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Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name

Patient Information

Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose,
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose,
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose,
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose,
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose,

Encounter Date

Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose,

18 years old

DOB -

(H)

Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose,
Patient Information Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose,

(W)

Verified Results

Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose, Serum Creatinine,
Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose, Serum Creatinine,
Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose, Serum Creatinine,
Encounter Date 18 years old DOB - (H) (W) Verified Results Test Name Glucose, Serum Creatinine,

Test Name

Glucose, Serum

Creatinine, Serum

eGFR If NonAfricn Am GFR Normal Chronic Kidney Disease Kidney Failure eGFR If Africn Am GFR Normal Chronic Kidney Disease Kidney Failure BUN

BU N/Creatinine Ratio

Sodium, Serum

Potassium, Serum

Chloride, Serum

Carbon Dioxide, Total

Calcium, Serum

Protein, Total, Serum

Albumin, Serum

Globulin, Total

NG Ratio

 

Result

 

Flag

Reference

93

mg/dl

65-99

0.83 mg/dl

 

0.76-1.27

>60 ml/min/1.732

 

>60

<60

<15

 

>60

ml/min/1. 732

 

>60

<60

<15

 

12

mg/dl

6-20

14

136 mmol/L

 

136-145

4.4

mmol/L

3.5-5.0

98

mmol/L

98-107

30

mmol/L

H

22-29

9.7

mg/dl

8.6-10.2

8.1

g/dl

6.4-8.3

4.8

g/dl

3.5-5.2

3.3

g/dl

1.5

1of4

   

Patient:

DOB:

Encounter:

iv!RN:

Patient: DOB: Encounter: iv!RN: Bilirubin, Total 0.8 mg/dL 0.1-1.2 Alkaline Phosphatase, S 70
Patient: DOB: Encounter: iv!RN: Bilirubin, Total 0.8 mg/dL 0.1-1.2 Alkaline Phosphatase, S 70

Bilirubin, Total

0.8 mg/dL

0.1-1.2

Alkaline Phosphatase, S

70

U/L

56-127

AST (SGOT)

20

U/L

5-40

~~!5~9P:r:J -------------------~\Ji~------------------~~41

Lipid Profile ( Comprehensive Panel) LDL References Ranges

(U.S. Department of Health and Human Services ATP Ill Classifications)

of Health and Human Services ATP Ill Classifications) Optimal <100 mg/dL Near Optimal 100-129 mg/dL
of Health and Human Services ATP Ill Classifications) Optimal <100 mg/dL Near Optimal 100-129 mg/dL

Optimal

<100 mg/dL

Near Optimal

100-129 mg/dL

Borderline High

130-159 mg/dL

High

160-189 mg/dL

Very High

>189 mg/dL

Test Name

Result

Flag

Reference

Cholesterol, Total Cholesterol Reference Ranges

193 mg/dL

0-200

(U.S. Department of Health and Human Services ATPlll Classifications)

Desirable Borderline High High Risk Triglycerides Triglyceride Reference Ranges:

< 200 mg/di 200-239 mg/di > 240 mg/di 146 mg/dL

·

0-150

(U.S. Department of Health and Human Services ATP Ill Classification)

Normal Borderline High High Very High HDL Cholesterol

<150 mg/dL 150-199 mg/dL 200-499 mg/dL >500 mg/dL 44 mg/dL

 

40-60

HDL Reference Ranges (U.S. Department of Health and Human Services ATP Ill Classifications)

Low

< 40 mg/di

(major risk factor for

CHO)

High

>60 mg/di

("negative" risk factor

 

for CHO) VLDL Cholesterol Cal 29 mgldL

 

LDL Cholesterol

Cale

120 mg/dL

H

0-100

LDL References Ranges (U.S. Department of Health and Human Services ATP Ill Classifications)

Optimal

<100 mg/dL

Near Optimal

100-129 mg/dL

Borderline High

130-159 mgldL

High

·

160-189 mg/dL

Very High

>189 mgldL

Panel Estradiol, Progesterone, Testosterone, DHEA-S, Cortisol ( LC Only)

2 of4

mg/dL Very High >189 mgldL Panel Estradiol, Progesterone, Testosterone, DHEA-S, Cortisol ( LC Only) 2 of4
mg/dL Very High >189 mgldL Panel Estradiol, Progesterone, Testosterone, DHEA-S, Cortisol ( LC Only) 2 of4
mg/dL Very High >189 mgldL Panel Estradiol, Progesterone, Testosterone, DHEA-S, Cortisol ( LC Only) 2 of4

Patient:

DOB:

Encounter:

1'1/RN:

Roche ECLIA methodology

DOB: Encounter: 1'1/RN: Roche ECLIA methodology Test Name Result Flag Reference Cortisol 13.1 ug/dL
DOB: Encounter: 1'1/RN: Roche ECLIA methodology Test Name Result Flag Reference Cortisol 13.1 ug/dL
Test Name Result Flag Reference Cortisol 13.1 ug/dL 2.3-19.4 Cortisol AM 6.2 - 19.4 Cortisol
Test Name
Result
Flag
Reference
Cortisol
13.1
ug/dL
2.3-19.4
Cortisol AM
6.2 - 19.4
Cortisol
PM
2.3 - 11 ~
.
~
Testosterone, Serum
741 ng/dl <3,0 h-- lo,~~
0-
MALE TANNERS
GE
l)
1
<
3
2
< 3 - 432
3
65 - 778
4
180 - 763
5
Progesterone
188 - 882
1.1 ng/ml
0.2-1.4
DHEA-Sulfate
}
402.1 ug/dl
416.7 pg/ml ,
115.3-459.6
L0
Estradiol
J,;J.:) ·""> lttt:J
H
7.6-42.6
~---~='------------~
Roche ECLIA methodology \'<\D'v'<--<>~{;;£
Panel Follicle Stirn Hornone ( FSH )
and Leutinizing Hormone ( LH) (
LC Only)
Result
Flag
Reference
7.3
mlU/mL
1.7-8.6
1.5
mlU/mL
1.5-12.4

Prolactin

7.3 mlU/mL 1.7-8.6 1.5 mlU/mL 1.5-12.4 Prolactin Testoserone Panel (Tot, Free, SHBG) Test Name Result
7.3 mlU/mL 1.7-8.6 1.5 mlU/mL 1.5-12.4 Prolactin Testoserone Panel (Tot, Free, SHBG) Test Name Result
7.3 mlU/mL 1.7-8.6 1.5 mlU/mL 1.5-12.4 Prolactin Testoserone Panel (Tot, Free, SHBG) Test Name Result

Testoserone Panel (Tot, Free, SHBG)

1.5-12.4 Prolactin Testoserone Panel (Tot, Free, SHBG) Test Name Result Flag Reference Free
1.5-12.4 Prolactin Testoserone Panel (Tot, Free, SHBG) Test Name Result Flag Reference Free

Test Name

Result

Flag

Reference

Free Testosterone(Direct)

17.0

pg/ml

Not Estab.

Sex Harm Binding Glob, Serum

31.2

nmol/L

16.5-55.9

Vitamin D 25 OH (Hydroxy)

Vitamin D deficiency has been defined by the Institute of Medicine and an Endocrine Society practice guideline as a level of serum 25-0H vitamin D less than 20 ng/ml (1,2). The Endocrine Society went on to further define vitamin D insufficiency as a level between 21 and 29 ng/ml (2).

D insufficiency as a level between 21 and 29 ng/ml (2). 1. IOM (Institute of Medicine).
D insufficiency as a level between 21 and 29 ng/ml (2). 1. IOM (Institute of Medicine).

1. IOM (Institute of Medicine). 2010. Dietary reference intakes for calcium and D. Washington DC: The National Academies Press.

2. Halick MF, Binkley NC, Bischoff-Ferrari HA, et al.

3 of4

calcium and D. Washington DC: The National Academies Press. 2. Halick MF, Binkley NC, Bischoff-Ferrari HA,

Patient:

DOB:

 

Encounter:

lvfRN:

Encounter: lvfRN:

Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. JCEM. 2011 Jul; 96(7):1911-30.

Test Name

Result

Flag

Reference

Vitamin

D, 25-Hydroxy

15.6 ng/ml

L

30.0-100.0

Vitamin D deficiency has been defined by the Institute of Medicine and an Endocrine Society practice guideline as a level of serum 25-0H vitamin D less than 20 ng/mL (1,2). The Endocrine Society went on to further define vitamin D insufficiency as a level between 21 and 29 ng/ml (2). 1. IOM (Institute of Medicine). 2010. Dietary reference intakes for calcium and D. Washington DC: The Natio.nal Academies Press. . 2. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice

Jl_1.!~d_e1i11_~~J_C_E:t\ll.~011

Jul; 96(71!.9_11:~9:

---··-···----·--···· --··----··

T3 Free

---··-···----·--···· --··----·· T3 Free Test Name R e s u l t F l a g
---··-···----·--···· --··----·· T3 Free Test Name R e s u l t F l a g

Test Name

Result

Flag

Reference

Triiodothyronine,Fre_e,Serum

3.5 pg/ml

2.3-5.0

_]

T4 (Thyroxine) Free

     
 

--.------·.,·--···--

 

--"-'"" --

.,

Test Name

Result

Flag

Reference

]

_ T4,Free(Direct)

1.41 ng/dl

0.93-1.70

 

T4 and TSH (LC Only)

       

Test Name

Result

Flag

Reference

TSH

2.79 ulU/mL

0.27-4.20

"fhyroxine (T4)

7.86 mcgldl

4.50-11.70

4 of4

. 2 7 - 4 . 2 0 "fhyroxine (T4) 7 . 8 6 m c

TRANSGENDER CARE: SUGGESTED HORMONE REGIMENS

Male-to-Female:

Estrogens:

Estradiol (Estrace®), 6 - 8 mg PO or sublingual qD (divided doses); or Conjugated estrogens (Premarin®), 5 mg PO qD (divided doses); or Estradiol (e.g., Climara®,) two 0.1 mg patches, changed weekly; or Estradiol valerate, 20 mg IM q two weeks.

Anti-androgen:

Spironolactone (Aldactone®), 100 - 300 mg PO qD (divided doses).

Progestogens: (usually optional) Micronized Progesterone (Prometrium®), I 00 mg PO BID; or Medroxyprogesterone (Provera®), 5 - I 0 mg PO qD

One possible regimen: start with a moderate estrogen dose (e.g., estradiol, 2 mg BID); one month

later, advance to a higher dose (e.g., estradiol, 6-8 mg qD, divided doses); one month later, add spironolactone, 100 mg BID or TIO. Subsequently add more estrogen or a progestogen as needed to achieve desired feminization, to eliminate spontaneous erections (an index of free testosterone), and to achieve serum testosterone levels in the female range and serum estradiol levels approximately

one-third

Consider transdermal estradiol for patients over age 40, and for those who have risk factors such as smoking, a personal or family history ofDVT or cardiovascular disease, etc.

After orchiectomy, estrogen can be decreased to one-quarter to one-half of the pre-op dosage, and anti-androgens can be discontinued.

to one-half of the female mid-cycle peak.

Female-to-Male:

Testosterone enanthate (Delatestryl®) or cypionate (Depa-Testosterone®), 150 - 250 mg IM q two weeks; or

Transdennal testosterone

Transdermal testosterone gel (Androgel®), 5 - 10 mg, applied daily.

patch (Androderm®), 5 - 7 .5 mg, changed daily; or

Transdermal testosterone provides slower masculinization and cessation of menses, but more uniform blood levels, and perhaps fewer side effects and problems with excessive dosage.

After oophorectomy, androgen can be decreased to one-half or less of the pre-op dosage.

SUGGESTED LABORATORY STUDIES

Male-to-Female:

Free testosterone, fasting glucose, liver function tests, and complete blood count - pre-treatment, at 6 and 12 months, and yearly thereafter. An estradiol level may be helpful if feminization appears to be inadequate. Prolactin - pre-treatment and at I, 2, and 3 years. If hyperprolactinemia does not occur during this time, no further measurements are necessary.

Female-to-Male:

Free testosterone, lipid profile, liver function tests, and complete blood count - pre-treatment, at 6 and 12 months, and yearly thereafter. Perform Pap smears in patients who have not had hysterectomy.

Anne A. Lawrence, M.D., Ph.D.

Feb. 2002