Full blood count (FBC) tests play a crucial role in gender-affirming therapy, offering insights into the health of individuals undergoing hormone therapy as part of their gender transition journey. However, abnormalities in FBC results can arise, necessitating a deeper understanding of their causes and appropriate actions. Here, we explore common abnormalities in FBC results, their potential causes, and steps to address them.

1. Hemoglobin:

a. Elevated Hemoglobin Levels:

• Causes: Increased hemoglobin levels, can occur as a result of hormone therapy, particularly in transgender men receiving testosterone. Other contributing factors may include dehydration, smoking, or underlying conditions such as polycythemia vera.
• What to Do: Close monitoring of hemoglobin levels is essential, particularly in individuals undergoing hormone therapy. Your doctor may adjust hormone dosages, recommend hydration strategies, or conduct further investigations to identify underlying causes requiring specific management.

b. Decreased Hemoglobin Levels:

• Causes: Anemia, characterized by a decrease in hemoglobin levels, may occur due to various factors, including blood loss (e.g., menstruation), inadequate iron intake or absorption or chronic diseases.
• What to Do: Treatment of anemia depends on the underlying cause. It may involve dietary adjustments or iron supplementation. In cases of severe anemia, blood transfusions or additional investigations to identify and address contributing factors may be necessary.

2. Red Blood Cells (RBCs):

a. Elevated RBC Count (Polycythemia):

• Causes: Polycythemia can occur as a result of hormone therapy, particularly with testosterone, leading to an increase in red blood cell production. It can also be influenced by factors such as dehydration or smoking.
• What to Do: Close monitoring is crucial, especially for individuals on testosterone therapy. If polycythemia is detected, adjusting the hormone dosages or hydration strategies is needed. In some cases, further evaluation may be necessary to rule out underlying conditions.

b. Decreased RBC Count (Anemia):

• Causes: Anemia may occur due to factors like menstrual bleeding in transgender men, inadequate iron intake, or changes in hormone levels. Chronic illnesses or gastrointestinal bleeding can also contribute to anemia.
• What to Do: Treatment may involve dietary adjustments, iron supplementation, or hormone therapy modifications. Consultation with a healthcare provider is essential to identify the underlying cause and tailor treatment accordingly.

3. White Blood Cells (WBCs):

a. Elevated WBC Count (Leukocytosis):

• Causes: Leukocytosis can result from stress or inflammation. Infections should also be considered as a potential cause.
• What to Do: Evaluation for underlying infections or inflammatory conditions is essential. Treatment may involve addressing infections with appropriate medications or managing stress through supportive interventions.

b. Decreased WBC Count (Leukopenia):

• Causes: Leukopenia may occur due to the immunosuppressive effects of certain medications or underlying conditions such as HIV/AIDS.
• What to Do: Close monitoring is necessary, especially in individuals with known risk factors for leukopenia. Your doctor could recommend interventions to support immune health.

4. Platelets:

a. Elevated Platelet Count (Thrombocytosis):

• Causes: Thrombocytosis can be associated with hormone therapy, particularly in transgender men on testosterone. It may also result from reactive changes in response to surgery or other stressors.
• What to Do: Regular monitoring is important, with adjustments to hormone therapy dosage if necessary. Further evaluation may be warranted to rule out underlying conditions requiring specific treatment.

b. Decreased Platelet Count (Thrombocytopenia):

• Causes: Thrombocytopenia may occur secondary to medications or underlying conditions such as autoimmune disorders.
• What to Do: Treatment involves addressing the underlying cause and may include adjusting medications or exploring alternative therapies. Regular monitoring and collaboration with your doctor is essential to manage thrombocytopenia effectively.

5. Haematocrit. For further reading please access this link.

6. Neutrophils:

a. Elevated Neutrophil Count (Neutrophilia):

• Causes: Neutrophilia may occur in response to stress, inflammation, or infections, including those related to surgical procedures.
• What to Do: Evaluation for underlying infections or inflammatory conditions is essential. Treatment may involve addressing infections with appropriate medications or managing stress through supportive interventions.

b. Decreased Neutrophil Count (Neutropenia):

• Causes: Neutropenia can result from certain medications, infections, or autoimmune disorders.
• What to Do: Close monitoring is necessary, especially in individuals with known risk factors for neutropenia. Your doctor may recommend interventions to support immune health.

7.Basophils:

a. Elevated Basophil Count (Basophilia):

• Causes: Basophilia, characterized by an increase in basophil counts, can occur in response to allergic reactions, inflammatory conditions, or certain infections. It can also be associated with chronic myeloid leukemia or other hematologic disorders.
• What to Do: Identifying the underlying cause is crucial. Further evaluation may include allergy testing, assessment for inflammatory conditions, or bone marrow examination in cases of suspected hematologic disorders. Treatment depends on the specific cause and may involve allergy management, anti-inflammatory medications, or targeted therapies for underlying conditions.

b. Decreased Basophil Count (Basopenia):

• Causes: Basopenia, a decrease in basophil counts, is less common and may occur as a result of stress, corticosteroid therapy, or acute infections.
• What to Do: Recognizing the context in which basopenia occurs is important. In most cases, basopenia does not require specific treatment beyond addressing the underlying condition. However, monitoring basophil counts over time may be necessary to ensure resolution and rule out underlying pathology.

8. Mean Corpuscular Volume (MCV):

a. Elevated MCV (Macrocytosis):

• Causes: Macrocytosis may occur due to factors such as vitamin deficiencies (e.g., vitamin B12 or folate), alcohol use, or certain medications. Hormone therapy itself is not typically associated with macrocytosis.
• What to Do: Further evaluation is necessary to identify the underlying cause, which may involve additional blood tests or dietary assessments. Treatment may include vitamin supplementation or lifestyle modifications.

b. Decreased MCV (Microcytosis):

• Causes: Microcytosis is commonly associated with iron deficiency anemia, which can occur due to menstrual bleeding or inadequate dietary intake.
• What to Do: Treatment involves addressing the underlying iron deficiency, which may include iron supplementation, dietary modifications, or adjustments to hormone therapy.

9. Mean Corpuscular Hemoglobin Concentration (MCHC):

a. Elevated MCHC:

• Causes: Elevated MCHC may indicate conditions such as hereditary spherocytosis or hemolytic anemia. It can also occur in dehydration or as a result of certain medications.
• What to Do: Further evaluation is necessary to identify the underlying cause. Treatment depends on the specific condition and may involve supportive measures, such as hydration or medication adjustments.

b. Decreased MCHC:

• Causes: Decreased MCHC may occur in conditions such as iron deficiency anemia or thalassemia. It can also result from chronic diseases or nutritional deficiencies.
• What to Do: Treatment involves addressing the underlying cause, such as iron supplementation for iron deficiency anemia or supportive measures for chronic diseases. Close monitoring is essential to assess response to treatment and ensure optimal outcomes.

10. Elevated Eosinophil Count (Eosinophilia):

• Causes: Eosinophilia may arise due to allergic reactions, parasitic infections, autoimmune diseases, or certain medications. It can also be a response to stress or inflammation.
• What to Do: Identification of the underlying cause is crucial. Depending on the etiology, treatment may involve managing allergies and addressing infections with appropriate medications. Further diagnostic tests may be necessary for accurate diagnosis and management.

b. Decreased Eosinophil Count (Eosinopenia):

• Causes: Eosinopenia is commonly associated with acute stress responses, such as trauma, surgery, or severe infections, where circulating eosinophils are redistributed to tissues. It can also occur in individuals receiving corticosteroid therapy.
• What to Do: Recognizing the context of acute stress or corticosteroid use is essential. In most cases, eosinopenia does not require specific treatment beyond addressing the underlying condition. However, close monitoring is warranted, especially if eosinopenia persists beyond the acute phase.

Through close monitoring, tailored interventions, and collaborative decision-making between individuals and their doctor, optimal management of FBC abnormalities can be achieved, ensuring the safety and wellbeing of individuals undergoing gender-affirming therapy. If you have concerns about abnormal FBC results, do not hesitate to reach out to your doctor for guidance and support tailored to your unique needs.