Patient Information

18 years old
DOB -
(H)
(W)
Verified Results

Test Name
Glucose, Serum
Creatinine, Serum
eGFR If NonAfricn Am
GFR Normal
Chronic Kidney Disease
Kidney Failure
eGFR If Africn Am





Encounter Date

>60
<60
<15

Result
93 mg/dl
0.83 mg/dl
>60 ml/min/1.732
>60 ml/min/1. 732

Flag Reference
65-99
0.76-1.27
GFR Normal >60
Chronic Kidney Disease <60
Kidney Failure <15
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
1of4
12 mg/dl
14
136 mmol/L
4.4 mmol/L
98 mmol/L
30 mmol/L
9.7 mg/dl
8.1 g/dl
4.8 g/dl
3.3 g/dl
1.5
6-20
136-145
3.5-5.0
98-107
H 22-29
8.6-10.2
6.4-8.3
3.5-5.2

Patient:
Encounter:


DOB:
iv!RN:
Bilirubin, Total
Alkaline Phosphatase, S
AST (SGOT)
0.8 mg/dL
70 U/L
20 U/L
0.1-1.2
56-127
5-40
_____________ _
Lipid Profile ( Comprehensive
Panel)

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 mg/dL
High 160-189 mg/dL
Very High >189 mg/dL
Test Name
Cholesterol, Total
Cholesterol Reference Ranges
Result
193 mg/dL
Flag
(U.S. Department of Health and Human Services ATPlll Classifications)
Desirable < 200 mg/di
Borderline High 200-239 mg/di
High Risk > 240 mg/di
Reference
0-200
Triglycerides 146 mg/dL 0-150
Triglyceride Reference Ranges:
(U.S. Department of Health and Human Services ATP Ill Classification)
Normal <150 mg/dL
Borderline High 150-199 mg/dL
High 200-499 mg/dL
Very High >500 mg/dL
HDL Cholesterol 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
Patient:
Encounter:


Roche ECLIA methodology
DOB:
1'1/RN:
Test Name
Cortisol
Result Flag Reference
13.1 ug/dL 2.3-19.4
Cortisol AM 6.2 - 19.4
Testosterone, Serum 741 ng/dl <3,0 h--
Cortisol PM 2.3 - 11 .
MALE TANNERS GE l) 0- . . .
1 < 3
2 < 3 - 432
3 65 - 778
4 180 - 763
5 188 - 882
Progesterone 1.1 ng/ml 0.2-1.4
115.3-459.6 DHEA-Sulfate } 402.1 ug/dl
Estradiol L 0 J,;J.:) ""> lttt:J 416.7 pg/ml , H 7.6-42.6
Roche ECLIA methodology
Panel Follicle Stirn Hornone ( FSH )
and Leutinizing Hormone ( LH) (
LC Only)
Prolactin
Testoserone Panel (Tot, Free,
SHBG)
Test Name
Free Testosterone(Direct)
Sex Harm Binding Glob, Serum
Result
7.3 mlU/mL
1.5 mlU/mL


Result
17.0 pg/ml
31.2 nmol/L

Flag Reference
1.7-8.6
1.5-12.4


Flag Reference
Not Estab.
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).
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 of 4
Patient:
Encounter:


Evaluation, treatment, and prevention of vitamin D
deficiency: an Endocrine Society clinical practice
guideline. JCEM. 2011 Jul; 96(7):1911-30.
Test Name Result
Vitamin D, 25-Hydroxy 15.6 ng/ml
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
DOB:
lvfRN:
Flag
L
Reference
30.0-100.0
_ Jul; ____ . ---------- -- ----
T3 Free
Test Name Result Flag Reference
_]
Triiodothyronine,Fre_e,Serum 3.5 pg/ml 2.3-5.0
T4 (Thyroxine) Free
l-. . ......................
--.------.,---- .... ., .. --"-'"" --
___ ]
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
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 to one-half of the female mid-cycle peak.
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.
Female-to-Male:
Testosterone enanthate (Delatestryl) or cypionate (Depa-Testosterone), 150 - 250 mg IM q
two weeks; or
Transdennal testosterone patch (Androderm), 5 - 7 .5 mg, changed daily; or
Transdermal testosterone gel (Androgel), 5 - 10 mg, applied daily.
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