From: Conceptual approach to developing quality measures for transgender patients
 | Title | Category | Denominator | Numerator |
---|---|---|---|---|
Measure 1. | Receiving ethinyl estradiol formulations (not recommended) | Hormone Management (TF). | TF patients who received an estrogen formulation | Patients who specifically received an ethinyl estradiol formulation |
Measure 2. | Receiving cyclical preparations of estrogen therapy (not recommended) | Hormone Management (TF). | TF patients who received an estrogen formulation | Patients who received cyclical preparations |
Measure 3. | Measurement of testosterone and estradiol levels after starting estrogen therapy | Hormone Management (TF). | TF patients who received an estrogen formulation for feminizing therapy | Patients who had a testosterone level and/or an estradiol level measured within 3 months of starting therapy, and twice within 6 months |
Measure 4. | Measurement of testosterone levels after starting testosterone therapy | Hormone Management (TM). | TM patients who received a testosterone formulation for masculinizing therapy | Patients who had a testosterone level measured within 3 months of starting therapy, and twice within 6 months |
Measure 5. | Supratherapeutic testosterone levels (not recommended) | Hormone Management (TM). | TM patients who received a testosterone formulation for masculinizing therapy | Patients who recorded a testosterone level above the normal male physiologic range |
Measure 6. | Supratherapeutic estradiol levels (not recommended) | Hormone Management (TF). | TF patients who received an estrogen formulation for feminizing therapy | Patients who recorded an estrogen level above the normal female physiologic range |
Measure 7. | Measurement of metabolic panel after starting spironolactone. | Hormone Management (TF). | TF patients who received spironolactone for feminizing therapy | Patients who had measurement of K, Cr, and BUN within 3 months of starting spironolactone |
Measure 8. | Measurement of metabolic panel after increasing the dose of spironolactone | Hormone Management (TF). | TF patients who received spironolactone for feminizing therapy and experienced a dose increase | Patients who had measurement of K, Cr, and BUN within 3 months of increasing the dose of spironolactone |
Measure 9. | Measurement of Hb and HCT after starting testosterone | Hormone Management (TM). | TM patients who started testosterone for masculinizing therapy | Patients who had measurement of Hb and/or HCT within 3 months of starting testosterone therapy |
Measure 10. | Patients with a history of hyperkalemia or renal insufficiency should not be given spironolactone | Hormone Management (TF). | TF patients who began spironolactone for feminizing therapy | Patients who had a history of hyperkalemia or renal insufficiency prior to beginning spironolactone |
Measure 11. | Adequate laboratory testing prior to beginning spironolactone | Hormone Management (TF). | TF patients who began spironolactone for feminizing therapy | Patients who had undergone measurement of potassium, BUN, and/or creatinine during the prior 6 months |
Measure 12. | Adequate laboratory testing prior to beginning testosterone | Hormone Management (TM). | TM patients who began testosterone for masculinizing therapy | Patients who had undergone measurement of Hb and/or HCT during the prior 6 months |
Measure 13. | Hormone therapy should not be given to patients with a history of hormone-responsive cancer | Hormone Management (TF and TM). | Patients who began estrogen or testosterone for feminizing or masculinizing therapy | Patients who had a history of breast, prostate, ovarian, or testicular cancer prior to beginning therapy |
Measure 14. | Pap smear not appropriate below age 21 | Cancer screening | TM patients age 18–20 | All such patients who received a Pap smear prior to age 21 |
Measure 15. | Bone densitometry needed for trans patients | Bone health | For TF: those who received at least 180 days of feminizing therapy For TM: all | DEXA scan at least once between age 60–70 |
Measure 16. | Estrogen should be given by the transdermal route in patients with elevated cardiovascular risk | Cardiovascular health | Recipients of estrogen for feminizing therapy, divided into cardiovascular risk categories based on comorbidities | Estrogen by transdermal vs. oral route |
Measure 17. | Estrogen should be given by the transdermal route in patients with prior venous thromboembolism | Cardiovascular health | Recipients of estrogen for feminizing therapy with history of prior venous thromboembolism | Estrogen by transdermal vs. oral route |
Measure 18. | Oral testosterone preparations are no longer recommended | Hormone Management (TM). | Recipients of testosterone for masculinizing therapy | Patients who received testosterone via the oral route (rather than transdermal or intramuscular) |
Measure 19. | Spironolactone should not be given, or should be given with caution, in those taking an angiotensin-converting-enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) | Hormone Management (TF). | Patients who received spironolactone for feminizing therapy | Patients who also received an ACE inhibitor or ARB concurrently |
Measure 20. | Mammography should be performed every 24 months for TM patients and for TF patients who received estrogen for feminizing therapy | Cancer screening | All TM patients, and those TF patients who received estrogen for feminizing therapy for at least 180 total days | Screening mammography at least every 24 months |