Plasma donation involves collecting the liquid portion of the blood, which contains proteins, antibodies, and clotting factors. These components are purified to create life-saving therapies for people with rare chronic diseases, immune deficiencies, and serious burns. Transgender individuals are eligible to donate plasma, but eligibility is determined by the same individualized risk assessment applied to all potential donors. This assessment focuses on recent medical procedures and current medications, not on gender identity itself.
Policy Shifts in Donor Eligibility
Blood and plasma donation policies have evolved significantly, moving away from broad, identity-based restrictions toward a focus on individual health and risk. Historically, eligibility for transgender individuals was complicated by policies aimed at men who have sex with men (MSM), which were established during the AIDS epidemic. These rules often determined eligibility based on the sex assigned at birth, causing confusion.
Regulatory bodies, including the U.S. Food and Drug Administration (FDA), have updated their guidelines to be more inclusive and scientifically grounded. The previous time-based deferral for MSM has been replaced with gender-inclusive, behavior-based questions. All potential donors are now asked the same questions regarding recent sexual activity, focusing on new or multiple partners and anal sex within the last three months.
This shift ensures all donors are screened equally, basing deferral on specific behaviors associated with a higher risk of transmitting infectious diseases, such as HIV. Organizations like the Association for the Advancement of Blood and Biotherapies (AABB) have played a large role in developing and implementing these modern guidelines.
Specific Medical Criteria Related to Transition
The most common factors influencing plasma donation eligibility for transgender individuals are the use of Hormone Replacement Therapy (HRT) and the timing of gender-affirming surgeries. A primary concern when donating plasma while on HRT is the potential for trace amounts of the medication to be passed to a recipient, which could be harmful in specific patient populations. For this reason, many donation centers require a temporary deferral depending on the specific medication and its half-life in the body.
Hormone Replacement Therapy (HRT)
For transgender women, certain anti-androgen medications require a deferral due to the risk of birth defects if the plasma were to be transfused to a pregnant recipient. Finasteride, often prescribed to block testosterone, requires a one-month waiting period from the last dose. Dutasteride, a similar medication that remains in the body for a longer period, requires a deferral of six months from the last dose.
Estrogen and other anti-androgens, such as spironolactone, may also lead to deferral, often related to donor safety. Spironolactone is a diuretic used to manage blood pressure, and a deferral may be put in place to ensure the donor’s cardiovascular system is stable enough to withstand the donation process. Stopping HRT solely for the purpose of donation is strongly discouraged by medical professionals, as it disrupts the therapeutic regimen and negatively impacts the donor’s health.
For transgender men, testosterone therapy is generally not a reason for exclusion from plasma donation, provided all other health criteria are met. However, one common side effect of testosterone is an increase in red blood cell production, a condition known as polycythemia. If the red cell count is too high, it presents a risk to the donor’s health, and a temporary deferral may be necessary until the count is lowered.
Gender-Affirming Surgery (GAS)
Gender-affirming surgery (GAS) requires a temporary deferral, with the length of time depending on the invasiveness of the procedure and the donor’s recovery progress. Minor procedures, such as a breast reduction or simple mastectomy, may only require a short waiting period of a few weeks once fully recovered. More complex procedures, like a phalloplasty or vaginoplasty, are considered major surgeries and typically require a deferral period ranging from six months to one year. A deferral is also necessary if the person received a blood transfusion during the surgery, which mandates a three-month waiting period.
The Practical Donor Screening Process
When a transgender individual arrives to donate plasma, the process begins with a detailed intake questionnaire that is now designed to be gender-neutral. This document collects information on the donor’s medical history, current health, and recent activities. The questionnaire serves as the first step in the individualized risk assessment for every person who attempts to donate.
Following the initial paperwork, the donor will participate in a private interview with a qualified center staff member, often called a medical historian. This one-on-one consultation is where the specifics of the donor’s medical regimen, including any HRT medications and recent surgeries, are discussed confidentially. The staff member reviews the medications against a comprehensive deferral list to determine if any waiting period is necessary before the donation can proceed.
Honest and complete disclosure of all medications and medical events is necessary to ensure the safety of both the donor and the plasma recipient. The staff is trained to apply the deferral rules based on the specific drug or procedure. The final determination of eligibility is made at the donation center based on the combination of the donor’s physical exam and the information provided during the screening process.