Trans and/or gender-diverse people

It may be harder to find cancer specialists who understand how 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

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.

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

Taking feminising hormones (such as oestrogen or testosterone blockers) may slightly increase the risk of breast cancer over time, but the risk is still much lower than for cisgender women. Current evidence shows that taking testosterone does not increase cancer risk. For most people, the benefits of gender-affirming hormones outweigh any small change in cancer risk.

Some cancers are screened and treated in a cisgender way (e.g. ovarian cancer in a women’s hospital). This can feel isolating if you are trans and/or gender diverse. Cancer care teams may also be less experienced treating people whose bodies don’t match typical gender expectations (e.g. a woman with prostate cancer), which can make care feel awkward. Support services may also be gendered (e.g. for prostate or breast cancer), which can make it harder to find the right support.

Everyone has breast tissue in the breast and chest area, which means anyone can 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 develop breasts from taking gender-affirming hormones have a higher risk than cisgender men, but a lower risk than 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.

The prostate is not removed during gender-affirming genital surgery (e.g. vaginoplasty). This means all trans and genderdiverse people who were born with a prostate can get prostate cancer. It’s 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 gender-affirming hormone therapy later in life and cancer had already started to grow 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 testosterone levels. 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 prostate symptoms
• PSA blood test results may look different if you’re taking hormones such as oestrogen
• you may not have any prostate cancer symptoms, or urinary symptoms may be mistaken for effects of gender-affirming surgery.

There are many cancers that affect reproductive organs, including cancer of the cervix, ovaries, vagina, vulva, testicles or penis. 

Some trans people have gender-affirming surgery to create a vagina or penis. Cancer can also develop in these body parts, but this is very rare. If you have concerns, talk to your doctor. 

At the time of my diagnosis I was still passing as female and I was able to ‘fit in’ in the necessary environments like gynae offices. The psychological impact of having gynaecological parts involved was not lost on me.

Jax Trans man, ovarian cancer

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 a front hole), radiation therapy may make this area dry, narrow or cause bleeding.

Your treatment team may suggest using dilators after treatment to help keep the vagina/front hole open. Dilators can help with cervical screening or sex, but it’s your choice whether or not to use them.

Pelvic radiation therapy may narrow the vagina or make the skin more fragile and sensitive. Keeping the vagina open and supple can make penetrative sex more comfortable and it’s also important for having medical examinations in the future.

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 recovery goals, so they can understand what you’d like and how you feel.

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.