Clinical needs for transgender men in the gynecologic oncology setting

Saúde sexual e reprodutiva de homens transgêneros e mulheres homoafetivas: Revisão Integrativa

“…Atualmente, não existem diretrizes específicas nas sociedades endócrinas ou ginecológicas delineando a vigilância sugerida para malignidades hormonalmente sensíveis em homens transgêneros em terapia hormonal de afirmação de gênero. Geralmente, a vigilância de rotina apropriada para a idade é recomendada, mas dados adicionais nesta população são necessários para avaliar mais completamente o risco e as variações na apresentação (Stenzel et al, 2020) A terapia com testosterona frequentemente induz amenorreia e aumenta a virilização, no entanto, faltam dados de segurança a longo prazo, pelo potencial mecanismo de aromatização para estrogênio. Isso poderia elevar o risco de cânceres hormonalmente responsivos, como o câncer de endométrio tipo I. Com base nos dados limitados, a testosterona não parece aumentar a hiperplasia endometrial em populações transmasculinas pré ou pós-menopáusicas; em muitos casos a testosterona induz atrofia semelhante ao que é visto em pacientes do sexo feminino cisgênero.…”

Implications for management of ovarian cancer in a transgender man: Impact of androgens and androgen receptor status

“…Overall, an increased risk of endometrial cancer and hyperplasia has not been identified. Increased prevalence of HPV-associated risk factors, nondiagnostic Pap test due to testosterone-induced cervical atrophy, and reduced screening as a result of non-inclusive environments and outreach all contribute to an increased risk of cervical dysplasia [31][32][33]. Breast cancer risk is reduced in transgender men compared to cisgender women, but there remains a risk even after mastectomy (also termed "top surgery") as thereconstructive chest surgery does leave some breast tissue [34].The recommendation is for periodical self-chest exams, but the evidence for efficacy is poor [33].…”

“…Caring adequately for transgender men in gynecologic oncology may pose additional challenges due to the incongruence between care for reproductive organs and gender identity, gendered terminology of "women's cancer", and being cared for by teams who have exclusively cared for cisgender women [33]. Ensuring a transgender-inclusive practice is paramount to providing patient-centered care and improving psychological outcomes.…”

“…This is all important in the acknowledgement and respect of gender identities in order to foster trust in the patient-physician rapport. Additionally, provider and support staff training and education is essential, as transgender persons may have had negative experiences with healthcare professionals, and providers have been consistently shown to feel ill-prepared for these interactions [33] (Fig. 1).…”

Examining Cervical Cancer Preventive Behaviors for Latinx Transmasculine Individuals among Medical Students

“…These negative experiences can often lead LTM to avoid seeking healthcare altogether [13]. Furthermore, despite some provider's intentions to provide high-quality healthcare to LTM, their lack of training and knowledge about LTM-specific healthcare needs, such as cervical cancer, might lead them to interact with patients in ways that can be perceived as negative [6,[14][15][16][17]. For example, research has documented how offering a self-swab option for human papillomavirus (HPV) testing (as opposed to provider-collected) can be a patient-centered behavior that increases cervical cancer screening among this population [5,18].…”