Transgender patients: considerations for routine gynecologic care and cancer screening

Abstract

In the last several years, demand for transgender care from gynecologists has increased significantly. Transgender people comprise a diverse group who do not identify with the sex they were assigned at birth. Worldwide, it is estimated that 25 million people identify as transgender. Some undergo hormonal and/or surgical treatment aiming to feminize or masculinize their bodies. Cross-sex hormone treatment for transgender women—individuals assigned as male at birth who identify themselves as women—includes exogenous estrogen and/or progestin administration in combination with anti-androgens, whereas testosterone is used for transgender men—individuals whose natal sex is women but identify themselves as men. Although it is usually rare, hormone-sensitive malignancies may arise, and long-term effects remain unknown. In addition, reconstructive surgeries may include breast augmentation and vaginoplasty (creation of a vagina) for transgender women, and chest masculinization surgery (bilateral mastectomy) and metoidioplasty (lengthening of the clitoris to create a microphallus) or phalloplasty (creation of a phallus) for transgender men. Evidence relating to breast and reproductive tract cancers in the trans population is limited and insufficient to estimate cancer prevalence, and recommendations for screening and preventive care depend on the patients’ hormonal and surgical status. Even less information exists regarding the sub-set of individuals with genetic predisposition for these malignancies. In this review, we aimed to summarize current recommendations for gynecologists and gynecologic oncologists regarding cancer screening and personalized cancer-risk assessment in transgender people.

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

“…O aumento do treinamento entre gestores e profissionais de saúde, além de melhorias gerais no sentido de compreender as barreiras ao acesso à saúde podem reduzir algumas disparidades. Pesquisas adicionais para triagem e vigilância do câncer nesta comunidade serão necessárias para entender quaisquer riscos adicionais potenciais e disparidades de sobrevivência experimentadas pelas MSG (Stenzel et al, 2020;Labanca et al, 2020).…”

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

“…In both studies, the most common surgery for transgender men was chest surgery, whereas a minority had undergone genital gender-affirming surgery-consistent with our case. Despite the prevalence, there is a paucity in preparedness for the nuances of care within this unique patient population [42].…”

“…Care environment improvements such as signage (gender-neutral terminology, and symbols, inclusive artwork and pamphlets, and magazines), gender-neutral restrooms, appropriate use of terminology, pronouns, and charting consistencies will promote inclusivity and reduce the risk of individuals being misgendered, or "dead-named" (use of a former name of a transgender person) [44]. Additionally, use of genderneutral gynecologic language when referring to anatomic and reproductive organs,and attention to the independence of gender identityand sexual orientation during clinical history-taking will foster inclusion [42]. For example, instead of referring to the vulva, labia, vagina, or uterus/ovaries, one could refer to external pelvic area, outer fold, genital opening, or internal organs, respectively [42].…”

“…Additionally, use of genderneutral gynecologic language when referring to anatomic and reproductive organs,and attention to the independence of gender identityand sexual orientation during clinical history-taking will foster inclusion [42]. For example, instead of referring to the vulva, labia, vagina, or uterus/ovaries, one could refer to external pelvic area, outer fold, genital opening, or internal organs, respectively [42]. This is all important in the acknowledgement and respect of gender identities in order to foster trust in the patient-physician rapport.…”

Overview of Gender Affirming Surgery for the Gynecologic Surgeon

“…patient over age 50 who has a body mass index >35, uses exogenous estrogen/progesterone for more than 5 years, or has a family history of breast cancer should receive annual mammography screenings. 17 If patients are sexually active, they should be screened for sexually transmitted infections. The USPSTF recommends screening for chlamydia and gonorrhea in ''sexually active women age 24 years and younger'' or patients at increased risk.…”