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Specific issues in screening for transwomen and transmen with past or current hormone use

Specific issues in screening for transwomen and transmen with past or current hormone use
  Transwomen (MTF) Transmen (FTM)
Breast cancer Discuss screening in patients >50 years with additional risk factors for breast cancer* Intact breasts: Routine screening as for natal females
Postmastectomy: Yearly chest wall and axillary exams
Cervical cancer Vaginoplasty: No screening Cervix intact: Routine screening as for natal females
No cervix: No screening
Prostate cancer Routine screening as for natal males N/A
Cardiovascular disease Screen for risk factors Screen for risk factors
Diabetes mellitus On estrogen: Increased risk Routine screeningΔ
Hyperlipidemia On estrogen: Annual lipid screening On testosterone: Annual lipid screening
Osteoporosis Testes intact: Routine screening as for natal males

Screen all patients >65 years

Screen patients age 50 to 65 if off hormones for >5 years

Postorchiectomy: Screen all patients >65 years

Screen patients age 50 to 65 years if off hormones for >5 years
* Estrogen/progestin therapy for >5 years, family history, body mass index (BMI) >35.
¶ While there is no evidence to support clinical breast examinations in this population, we perform yearly chest wall and axillary exams and use this as an opportunity to examine scar tissue, examine any changes, and educate the patient about the small but possible risk of breast cancer.
Δ Transmen with polycystic ovary syndrome (PCOS) should be screened for diabetes as for natal females with PCOS. Refer to the UpToDate material on further evaluation after diagnosis of PCOS in adults.
Graphic 102596 Version 2.0