Trans and/or gender-diverse people

Lack of experience – It may be harder to find cancer specialists with an understanding of the ways in which trans health needs affect cancer care. It can be difficult dealing with health professionals who think of sex as binary and you may fear being misgendered.

Misgendering – Health professionals may incorrectly assume your gender or that of your partner and use the wrong words or pronouns when referring to you. You might find this misgendering upsetting and it could undermine your trust and confidence.

Outdated forms – Many medical forms do not include options to record your gender, pronouns and sexual orientation. It can also get complicated if the gender or name you use on the form doesn’t match the details on other official documents, such as your Medicare card.

Using gender-affirming hormones for a long time – Taking oestrogen for a long time may increase the risk of breast cancer. At this stage, it isn’t clear if taking testosterone for a long time increases cancer risk.

Services that are gendered – Some cancers are screened and treated in a cisgender way (e.g. ovarian cancer in a women’s hospital), which can feel isolating if you are trans or gender diverse.

Ways to manage challenges

• See a health professional who is affirming of your gender. To find a suitable doctor, use word of mouth or search TransHub.
• Look for services that are trans friendly.
• Tell your cancer care team about your relevant anatomy, the sex you were assigned at birth, and any hormone therapy you’re taking. This can help the team recommend treatments and give you information that is right for you.
• Ask the receptionist to update your record with your name and pronouns, or consider wearing a pronoun badge or pin.
• Practise what you want to say to your doctor before an appointment to help the words come out more easily. Or read from a pre-prepared letter. Avoiding eye contact may make it easier.
• Let your health professionals know what language you are comfortable with for body parts.
• Bring someone to your appointments for support. They can speak for you if you don’t know what to say, get tongue-tied or freeze in a challenging  situation.
• Use the Genders, Bodies and Relationships Passport to make telling your health professionals about your gender, body and relationships easier.
• Explain what is important to you. This could include concerns about whether you will be able to continue gender-affirming treatment.
• Visit Can We to find screening programs that are right for you.
• Consider making a complaint if you think you’ve been treated inappropriately.

Cancer can affect anybody, but there may be additional distress involved for trans people who have cancer in body parts that their doctors may not expect due to their gender, e.g. trans men with cervical cancer, trans women with prostate cancer, or non-binary people with any form of cancer.

It is important to screen for the parts of your body that you have. If you have had surgery to remove certain body parts (e.g. a mastectomy/top  surgery, or reproductive organ/s), it can be helpful to talk with your surgeon and health care team about what (if any) cancer risk still remains after that surgery.

Breast cancer – Everyone has breast tissue in the breast and chest area, which means they could get breast cancer. But risks can vary:

• Trans and gender-diverse people who develop breasts at puberty have a similar level of risk to cisgender women.
• Trans women and gender-diverse people who have breasts from taking gender-affirming hormones have a similar level of risk to cisgender women.
• Trans men and other people who have had gender-affirming top surgery have a lower risk of developing breast cancer than cisgender women, but may still need to screen for breast cancer in the future.

Having a mastectomy for cancer is different from gender-affirming top surgery. A mastectomy removes all the breast tissue from half or all of the chest area and often the nipple. Top surgery usually keeps some breast tissue that can be formed into a masculine chest and often the nipple is retained. You may have had this procedure before you were diagnosed with cancer.

Prostate cancer – The prostate is not removed during genital reconfiguration (also known as sexual reassignment surgery or SRS). This means all trans and gender-diverse people who were born with a prostate can get prostate cancer. It is common for the prostate to grow larger with age. You may be at higher risk of prostate cancer if you have a family history of prostate cancer, or if you started hormone therapy for gender affirmation later in life and already had some cancer in your prostate.

Taking feminising hormones (such as oestrogen, or testosterone blockers) or having your testicles removed, reduces your risk of prostate cancer by lowering the levels of testosterone. Although the risk of prostate cancer is likely to be low, keep in mind the following:

• if your doctor does not know your trans status, they may not ask about any potential prostate symptoms
• your PSA blood test results may look different if you are taking hormones like oestrogen
• you may not have any prostate cancer symptoms, or symptoms such as urinary problems may be mistaken for symptoms related to gender-affirming surgery.

Other cancers of the reproductive organs – There are a range of cancers that affect reproductive organs, including cancer of the cervix, ovaries, testicles or penis. If you have any symptoms including pain, discomfort, or a change in feeling or function of these body parts, it is important to see a trusted doctor about them.

Some cancer treatments can have an effect on your identity. Talk to your cancer care team about what is important to you so this can be considered when working out your treatment options.

Surgery

Surgery to treat cancer may result in physical changes that make you feel uncomfortable or distressed about your body (dysphoria). Or surgery can affirm your gender and/or ease existing feelings of gender dysphoria. It’s okay to not be sure how you’re feeling or how you will feel.

If you need to stay in hospital, ask what ward you will stay on. You may be able to stay in a private room or mixed-gender ward. It can feel isolating to receive treatment in settings that do not reflect your gender.

Radiation therapy

If you have had genital reconfiguration, including surgery to make a penis or vagina, radiation therapy to the pelvic area may affect these organs.

If you have had surgery to make a penis – Pelvic radiation therapy can usually be given in a way that avoids this area. If you also still have a vagina (sometimes described by trans people as front hole), radiation treatment team may suggest using dilators regularly after treatment to help keep your vagina/front hole open. While dilators can be helpful for continuing to have cervical screening or sex, it’s your choice whether or not to use them.

If you have had surgery to make a vagina – Pelvic radiation therapy may narrow the vagina or make the skin more fragile and sensitive. Keeping the vagina open and supple will make penetrative sex more comfortable, but it is also important for having medical examinations in the future or screening tests. You may be offered dilators to prevent scarring and shortening of the vagina. Some people find using a dilator upsetting. Talk to your doctor about your treatment goals, so they can understand what you’d like and how you feel.

If you have had other genital surgery – Other genital surgeries, including zero-depth vaginoplasty (to create a vulva) and metoidioplasty (to create a penis from the clitoris), may also be affected by radiation therapy. Talk to your surgeon and treatment team about what to expect and how you can look after yourself.

Using gender-affirming hormones during treatment

If you are taking gender-affirming hormones, you may be able to continue taking them during cancer treatment. This will depend on the type of cancer and treatment you had.

Talk to your team about the possible risks and benefits before you make any decisions about taking a break, stopping or reducing your  gender-affirming hormone treatment.

Your reasons for taking the hormones are also important and you may feel the benefits of continuing to take them outweigh the risks for you.

Some treatments for cancer may change how you look or affect a part of your body that aligns with your gender. For example, hair loss or a change in your body shape may be upsetting if your appearance is an important part of your identity. These changes may affect your body image and sense of self, and can be difficult to cope with.

You may also feel relieved if the changes affirm your gender. For example, surgery to treat cancer may remove a body part that you would prefer not to have. Or you may feel distressed if the changes threaten how comfortable you are in your body. How you react will depend on the type of cancer and treatment you have.