Social justice and laboratory medicine are not often uttered in the same sentence.  However, these two spheres overlap more than we might realize, as part of the laboratory’s work is defining expected biological variations for diverse populations. We in laboratory medicine have a responsibility to assess how pathological laboratory results from minority populations may be inconsistent with those defined for the dominant culture.

Two sessions today deal with this often overlooked connection. In a brown bag today, Tiffany Roberts, PhD, will draw from her own research with transgender individuals in presenting, “What is a Normal Result for a Transgender Patient?” Roberts will address transgender biological variability, and explore how even routine laboratory monitoring of transgendered patients can be challenging. For example, it is unclear which reference intervals are most appropriate for a transgender patient—sex at birth or identified gender. Some have advocated developing new reference intervals to safely monitor transgender patients on hormonal therapy.

Social justice aims to restore equal rights amongst diverse populations; laboratory medicine aims to correctly indicate when a specific result triggers medical alarm. The transgender population challenges social norms because they personify the differences between biological sex and gender.  Meaning, biological sex—defined by anatomical characteristics and chromosomal make-up—can be discordant with a person’s gender.

A transgender person is someone who identifies with a gender different from the biological sex they were assigned at birth.  While identifying as transgender is not a disease, the social stigma that often accompanies this sex/gender discordance can lead to gender dysphoria or extreme distress over their gender identity.  While some transgender people pursue no medical intervention, others undertake a variety of treatments to “transition” to their identified gender. Most commonly, hormone therapy is utilized, but some individuals may opt for surgical reconstruction.  Given the range of treatments and the bi-directionality of male to female vs. female to male there is incredible diversity within this population. 

Another session that shows this connection between seeking justice and improving health through laboratory medicine is a short course this afternoon, “Laboratory Medicine’s Role in Reducing Health Disparities.” Moderated by Octavia Peck Palmer, PhD, DABCC, the course will explore both the social and genetic implications of how race relates to laboratory medicine. Using three prime areas of clinical pathology (pregnancy, sepsis, and pulmonary function), Palmer and colleagues Alison Woodworth, PhD, DABCC and Melinda Aldrich, PhD, MPH will advocate and outline ways in which laboratorians can assist in predicting, managing, and preventing diseases with significant racial health disparities.

Ultimately, it takes awareness to provide equal services to the diverse populations represented in our communities. By using the knowledge that these populations may have physiological differences in their healthy state, laboratorians can help breakdown the social and medical disparities that currently exist.