Transgender: Staying Healthy

Knowing your specific health care needs

As a transgender person, you may have special health concerns. Being honest and open with your doctor will help you get the best care possible. So when talking with your doctor, tell them about:

• All past and planned gender-affirming care. Such care may involve treatments, such as hormone therapy or surgery. They may have risks. For example, transgender women taking estrogen may be more at risk for stroke and heart disease. Anesthesiologists and surgeons need to know if a transgender woman has had surgery around the vocal cords because this may make intubation before surgery more complicated. Transgender women also need to be screened for osteoporosis. This is especially needed if they stopped taking estrogen for any reason.

• Any unprescribed care. This may include hormones you got from the internet or supplements, such as black cohosh. Also tell your doctor if you have had silicone injections. They can put you at risk for HIV if you share needles.

• Your family history. Health problems that run in your family, such as heart disease, can affect your care. For instance, transgender men who have breast or ovarian cancer in their families may want to think about genetic testing for these diseases.

• Your mental health. Transgender people are more at risk for mental health problems like depression and anxiety. If you suffer from such a problem, your doctor can help you get treatment.

• Family planning. Gender-affirming care can affect your fertility. If you still want to have a family, you have choices, such as freezing sperm or eggs for later use. You may also want to think about birth control, if needed.

• Your sexual history. Your doctor can tell you if you need to be screened or tested for any sexually transmitted infections.

• Substance use. Drinking too much alcohol, using nonprescription drugs, and smoking can raise your risk for some health problems.

Getting the right preventive care

Preventive care, such as screenings, can help protect you from diseases such as cancer and diabetes. The screenings you need are mostly the same as those for cisgender people. But some gender-affirming care, such as taking hormones, may change that.

Transgender women (assigned male at birth) may need to be screened for:

• Breast cancer. Screening advice varies among experts. Talk with your doctor to help you decide about mammogram screening. You may have a higher risk for breast cancer depending on things like how long you have been on gender-affirming hormone therapy, the dose, and other risk factors like smoking. You may then need a mammogram after age 50 or earlier depending on other risk factors.

• Prostate cancer. Transgender women are still at risk for prostate cancer even if they have had surgery to change their sex.

Transgender men (assigned female at birth) may need to be screened for:

• Breast cancer.

  • Transgender men who have intact breasts should have mammograms. The U.S. Preventive Services Task Force advises mammograms every other year starting at age 40. The American Cancer Society advises that people ages 40 to 44 have the choice to start yearly mammograms. They advise yearly mammograms for ages 45 to 54 with the option to switch to every other year at age 55.

  • Even if you have your breasts removed, you may still have a low risk for breast cancer. You may need a mammogram or other imaging tests on a routine basis.

  • Talk with your doctor to help you decide about screenings.

• Cervical cancer. It’s best to still have screenings for this disease, unless you have had a total hysterectomy.

Also talk with your doctor about your risk for heart disease and osteoporosis. You may need tests for these diseases based on your risk. Your doctor will also discuss any vaccines you may need.