Trans-Specific Health Screening

If an individual has a body part or organ and meets screening criteria then guidelines for screening should be followed regardless of hormone use3

Cardiovascular Disease & Lipids

Feminizing hormone therapy likely increases risk of myocardial infarction and stroke1

Feminizing hormone therapy definitely increases risk of venous thromboembolism1

Testosterone may cause changes associated with cardiovascular disease, but studies are inconclusive1,2

Cardiovascular risk calculators do not account for hormone therapy

Affirmed gender may be more appropriate for those who have been on hormone therapy since adolescence or young adulthood3

Diabetes Mellitus & Polycystic Ovarian Syndrome (PCOS)

Transgender men have much higher rates of PCOS than natal men and thus should be screened for diabetes2

Transgender women on estrogen therapy may be at higher risk for diabetes4,5

Osteoporosis Screening

No accepted guidelines exist, however screening those who meet the following criteria is recommended:3,6

Any age, has undergone gonadectomy, and has a history 5 years without hormone replacement

Ages 50 and 64 years with risk factors for osteoporosis, including patients on androgen blockers or GnRH analogues

All transgender people age 65 years

Prostate Cancer

Prostate cancer rates are low, but possibly underreported, in those on feminizing hormone therapy9

Prostate specific antigen levels are suppressed by anti-androgen therapy9

At age 50, prostate monitoring should be considered for transwomen9

Breast Cancer

Intact breasts: Screening is the same as for natal females3

Hormone therapy: Does not appear to increase breast cancer risk in transgender individuals, but there is also insufficient evidence10,11

Guidelines generally recommend screening for transgender people11

Mastectomy: Risk of breast cancer is greatly reduced with chest surgery2,7

Yearly chest wall and axillary exams to examine scar tissue and changes12

Small but possible risk of breast cancer13

Transgender women

Mammography screening should be performed every 2 years after age of 50 and 5-10 years of feminizing hormone criteria have been met14

Discussions should include the risks of over screening and an assessment of individual risk factors14

Cervical cancer:

Cervix Intact & Subtotal Hysterectomy:

Cervical cancer screening as recommended for the general population3

Total hysterectomy (No Cervix):

Screening is unnecessary for most persons with a total hysterectomy 16,17

Neovagina:

Those who have undergone vaginoplasty should receive annual pelvic examinations to screen for pelvic cancer18

No evidence to suggest benefit from routine Pap screening except in those who have a neocervix formed from the glans penis18

References:

1. Irwig MS. Cardiovascular health in transgender people. Rev Endocr Metab Disord. 2018;19(3):243-251. doi:10.1007/s11154-018-9454-3 [doi]. https://doi-org.libraryproxy.quinnipiac.edu/10.1007/s11154-018-9454-3

2. Gorton R, Women L, Buth J. Medical therapy and health maintenance for transgender men: A guide for health care providers; 2005. https://www.researchgate.net/publication/239573753_Medical_Therapy_and_Health_Maintenance_for_Transgender_Men_A_Guide_For_Health_Care_Providers

3. UCSF Transgender Care, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People; 2nd edition. Deutsch MB, ed. June 2016. Available at transcare.ucsf.edu/guidelines.

4. Davison SL. Androgens in women. The Journal of Steroid Biochemistry and Molecular Biology. 06/2003;85(2-5):363-366. doi: 10.1016/s0960-0760(03)00204-8. https://www-ncbi-nlm-nih-gov.libraryproxy.quinnipiac.edu/pubmed/?term=Davison+S%2C+and+Davis+S.+%E2%80%9CAndrogens+in+women.%E2%80%9D+J+Steroid+Biochem+%26+Molec+Biol.+85+363-366.+2003

5. Elbers JM, Giltay EJ, Teerlink T, et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol (Oxf). 2003;58(5):562-571. doi: 1753 [pii].

6. Radix, Asa, Deutsch, MB. “Bone Health and Osteoporosis.” Bone Health and Osteoporosis | Transgender Care, University of California, San Francisco, 17 June 2016, transcare.ucsf.edu/guidelines/bone-health-and-osteoporosis.

7. Wierckx K, Elaut E, Declercq E, Heylens G, De Cuypere G, Taes Y, et al. Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study. Eur J Endocrinol Eur Fed Endocr Soc. 2013 Oct;169(4):471-8.

8. Wierckx K, Mueller S, Weyers S, Van Caenegem E, Roef G, Heylens G, et al. Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med. 2012 Oct 1;9(10):2641-51.

9. Gooren L, Morgentaler A. Prostate cancer incidence in orchidectomised male-to-female transsexual persons treated with oestrogens. Andrologia. 2014;46(10):1156-1160. doi: 10.1111/and.12208 [doi]. Accessed January 28, 2020.

10. Gooren L. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. The Journal of Sexual Medicine. 2013-12;10:3129-3134. https://www-ncbi-nlm-nih-gov.libraryproxy.quinnipiac.edu/pubmed/?term=Breast+cancer+development+in+transsexual+subjects+receiving+cross-sex+hormone+treatment

11. Meggetto O, Peirson L, Yakubu M, et al. Breast cancer risk and breast screening for trans people: An integration of 3 systematic reviews. CMAJ Open. 2019;7(3):E598-E609. doi: 10.9778/cmajo.20180028 [doi]

12. Gooren L. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. The Journal of Sexual Medicine. 2013-12;10:3129-3134. https://www-ncbi-nlm-nih-gov.libraryproxy.quinnipiac.edu/pubmed/?term=Breast+cancer+development+in+transsexual+subjects+receiving+cross-sex+hormone+treatment

13. Gooren L, Bowers M, Lips P, Konings IR. Five new cases of breast cancer in transsexual persons. Andrologia. 2015;47(10):1202-1205. doi: 10.1111/and.12399 [doi].

14. Deutsch, Madeline B. “Screening for breast cancer in transgender women.” Screening for Breast Cancer in Transgender Women | Transgender Care, University of California, San Francisco, 17 June 2016, https://transcare.ucsf.edu/guidelines/breast-cancer-women

15. Peitzmeier SM, Reisner SL, Harigopal P, Potter J. Female-to-male patients have high prevalence of unsatisfactory paps compared to non-transgender females: Implications for cervical cancer screening. J Gen Intern Med. 2014;29(5):778-784. doi: 10.1007/s11606-013-2753-1 [doi].

16. US Department of Health and Human Services. “More Women Getting Pap Tests as Recommended Some Women Get Pap Tests without Need .” CDC.gov, Centers for Disease Control and Prevention, 3 Jan. 2013, www.cdc.gov/media/releases/2013/p0103_pap_test.html.

17. US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for cervical cancer: US preventive services task force recommendation statement. JAMA. 2018;320(7):674-686. doi: 10.1001/jama.2018.10897 [doi].

18. Lawrence A. (2001) Vaginal Neoplasia in a Male-to-Female Transsexual: Case Report, Review of the Literature, and Recommendations for Cytological Screening. IJT 5,1, http://www.symposion.com/ijt/ijtvo05no01_01.htm

19. Wesp, Linda. “Transgender patients and the physical exam.” Transgender Patients and the Physical Exam | Transgender Care, University of California, San Francisco, 17 June 2016, http://www.transcare.ucsf.edu/guideliens/bone-health-and-osteoporosis

20. Feldman, J, Deutsch, MB. Primary care of transgender individuals. In:UpToDate, Elmore, J (Ed), UpToDate, Waltham, MA.

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