Cancer screenings and navigating healthcare
Cancer screenings
We should recall the obvious here: a trans person who is not on HRT should be screened for the same affections as for people of their assigned gender at birth. More specifically, transfeminine people not on HRT should be screened for prostate cancer after 55, and transmasculine people not on HRT (and without mammectomy) for breast and cervix cancer.
Breast
- Transfeminine people on HRT usually trade their risks of prostate cancer for risks of breast cancer. Getting screened for breast cancer hence becomes important for transfem people on hormones, and even more after 45 and if you have family history of breast cancer.
- The lowered risks of breast cancer that masculinizing therapy comes with should not dispense transmasculine people who haven’t got mammectomy to also get screened.
Prostate (before and after SRS)
Similarly, the lowered risks of prostate cancers in transfem people on hormones should not be read as an invitation to completely disregard the risks. There are many other risk factors to prostate cancer. Androgens mainly play a role on maintaining and aggravating prostate cancer, other factors can start it.
Note
Clinical prostate cancer screening (touch) should be performed differently depending if you had or not a vaginoplasty (with vaginal cavity). If you didn’t, the rectal examination remains the way to go. But post-SRS (with vaginal cavity), it makes more sense to examine the prostate through the vagina, as the vaginal cavity is created between the rectum and the prostate. An examination through the neovagina will reduce the amount of tissue walls, and hence be more precise. Many practitioners will not be aware of this, and an explanation will probably be required from you.Cervix (pap-smear)
Pap-smear and screening for uterine and cervical cancers should also be performed on transmasculine people on testosterone who have not undergone hysterectomy.
-
So, to sum up, your hormonal treatment will rebalance your risks for hormone-dependent cancers, but since there are many other risk factors, you should never consider yourself immune to these cancers because of your HRT.
-
As opposed to what many practitioners seem to forget, your general health continues to be an intricate combination of many factors, and can never be solely reduced to your HRT. It seems silly to recall, but trans people still have affections that have nothing to do with their HRT and them being trans.
-
The tendency of many practitioner to immediately accuse the HRT for all affection you come with, or to assume that a trans person can only seek trans-related care is sometimes called the “broken arm syndrome”: a trans person comes to seek care because they broke their arm in a fall, and the doctor would be like “your hormone levels are wrong”. Or, as another example, the author of this section has nearly been denied an appointment with a urologist who happened to also performed SRS, because she was not believed to be seeking care in urology and not for SRS.