Addressing Needs of Transgender Patients: The Role of Family Physicians

Asa E. Radix, MD, PhD, MPH


J Am Board Fam Med. 2020;33(2):314-321. 

In This Article

Primary Care

Transgender patients who have not undergone gender-affirming care (hormones or surgeries) can use the preventive care recommendations suitable for their assigned birth sex. Although there have not been well-conducted, long-term studies that demonstrate an increase in breast cancer incidence, the Endocrine Society and the University of California at San Francisco (UCSF) primary care guidelines recommend that transgender women who have received estrogen therapy and have developed breasts be offered mammography following the guidelines for cisgender women.[15,24] Transgender men who have a cervix need to be screened for cervical cancer, following the recommendations for cisgender women. Transgender men who have been on testosterone for more than 6 months have an increased risk of unsatisfactory Papanicolaou results, possibly due to testosterone induce atrophy.[36] Cervical cancer screening using self-collected swabs for human papillomavirus testing has been found to be feasible and acceptable and may be an option for those who are reluctant to undergo examination and collection by a medical provider.[37] Transgender men who have had bilateral mastectomy have been found to be at lower risk for breast cancer; however, cases do occur.[38–40] Current guidelines for transgender men recommend chest-wall exams after mastectomy as well as a discussion of the risks and benefits of mammography.[15,41] Transgender men who have the capacity for pregnancy, that is, have a uterus and ovaries, can get pregnant while on testosterone[42] and may therefore need counseling about fertility and contraceptive options.[43] There are no standard guidelines addressing when to start screening for osteoporosis in transgender women; however, 1 author suggests starting after age 40 years if risk factors are present.[22]