Transgender (trans) or gender diverse (TGD) people are estimated to comprise approximately 0.1%-2% of the population. Like many human traits, gender is diverse and has a biological basis. Many TGD people undergo masculinising or feminising gender-affirming hormone therapy and/or surgery to align their physical characteristics with their gender identity. Many cancers are known to be sex hormone-dependent yet uptake of screening by TGD people can be challenging. This is often related to fear of mistreatment in healthcare settings as well as distress or dysphoria towards secondary sexual characteristics such as the cervix in trans men.
There are no well-designed studies of sufficient duration to suggest that gender-affirming hormone therapy increases the risk of hormone-dependent cancers. Further studies are required. Until then, cancer-screening guidelines should be no different from the general population, based on the presence of organs in TGD people and not based on gender identity or hormonal therapy status. Trans women can develop prostate cancer and trans men can develop gynaecological cancers.
In TGD people who have been diagnosed with cancer, interactions with hospitals and health care professionals can be traumatic. This is understandable given that 28% of TGD Australians have experienced discrimination in healthcare settings and many have been refused care. Respect and sensitivity towards TGD people are required, including the use of inclusive language in interactions, use of preferred names (which may differ from hospital identity labels) and use of pronouns (i.e she/he/they), whilst acknowledging the presence of organs which may not be in keeping with one’s gender identity. Many breast cancer or prostate cancer resources, support groups and health services are not only highly gendered, but may not be inclusive of LGBTIQ+ individuals which needs to be considered to ensure all people can benefit from healthcare services and cancer organisations.