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    Gender Affirming Care
    Read the story of ASCP Patient Champion Julie and learn about the role
    of laboratory testing in her gender affirming care.

What is assigned sex?

Assigned sex is the sex that infants are assigned at birth based on the appearance of their external anatomy. They are assigned either “male” or “female” and an M or F is put on their birth certificate. However, sex is complex and cannot be fully defined by anatomy. Approximately 1.7% of people are born intersex, meaning they do not have reproductive or sexual anatomy that neatly fits the boxes of “male” and “female”


What is gender identity?

Gender identity is a person’s internal, deeply held knowledge of their own gender. Most people’s gender identity matches the sex they were assigned at birth. These people are cisgender. Transgender people identify as a gender that is different than the one that was assigned to them at birth. Some transgender people identify with a binary gender (“man” or “woman”). Others are nonbinary. Nonbinary is a term that covers a broad spectrum of labels and experiences outside of the binary gender categories of “man” and” woman”


What is gender expression?

Gender expression is the external manifestation of a person’s gender. This can include their name, clothing, appearance, and/or behavior and varies from culture to culture. Most transgender people align their gender expression to match their gender identity.

What is sexual orientation?

Sexual orientation is not the same as gender identity or gender expression. Sexual orientation is who a person is romantically, physically, and/or emotionally attracted to.


What is gender dysphoria?

Gender dysphoria is the psychological distress caused by a mismatch between a person’s gender identity and their sex assigned at birth. Many, but not all, trans people experience gender dysphoria. To combat gender dysphoria, many transgender individuals pursue gender affirming care. Gender affirming care can include medical affirmation such as hormonal treatments and puberty suppression and/or surgical affirmation such as breast augmentation, facial feminization surgery, or phalloplasty (surgical creation of a penis).



Educational Materials: Gender Affirming Care

Julie’s Story



Julie (She/her/They/Them/Siya) is a clinical lab technologist and humanitarian aid worker. When she was 24, started her medical transition while living in the Philippines. She was unable to find a gender affirming provider, so she started self-medicating hormone therapy. Hormone Therapy affects organ systems throughout the body and needs to be closely monitored through routine blood tests. Since Julie worked in a clinical laboratory, she was able to monitor her hormone levels and organ function.

After she moved to the United States, Julie was able to find an endocrinologist to manage her care. It was challenging to find someone who was trauma informed with experience with trans patients, and she often had to advocate for herself and ask for specific tests that she knew were affected by her treatment.

When Julie first began hormone therapy, she got monthly blood tests to monitor her treatment. Now that she and her doctors have found treatment that works for her, she gets annual blood tests to monitor her hormones and organ function.

“The lab saves my life every time that rainbow of draw tubes is collected to check if my organs are functioning well with all the medications I am taking with hormone treatment.”

Professionally, Julie is a passionate advocate for making the lab a more trans affirming space. She emphasizes that the lab is an essential part of the tool kit of care but can do more harm than good. It can be incredibly hurtful for a patient to be misgendered during a blood draw or have the wrong gender marker on their medical record.

“We need to connect the gap between having a compassionate laboratory, a holistic provider and a well aware patient.”


Hear Julie on the Inside the Lab Podcast Season 1 Episode 12 on Transgender Pathology