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Transgender patients: considerations for routine gynecologic care and cancer screening
  1. Trinidad Labanca1,2,
  2. Ivan Mañero3 and
  3. Marcelo Pannunzio1
  1. 1Department of Gynecology, Hospital Municipal Dr. Bernardo Houssay, Buenos Aires, Argentina
  2. 2Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  3. 3Department of Plastic Surgery, Instituto de Cirugía Plástica Dr. Ivan Mañero, Barcelona, Spain
  1. Correspondence to Dr Trinidad Labanca, Department of Gynecology, Hospital Municipal Dr. Bernardo Houssay, Buenos Aires, Argentina; trini.labanca{at}gmail.com

Abstract

In the last several years, demand for transgender care from gynecologists has increased significantly. Transgender people comprise a diverse group who do not identify with the sex they were assigned at birth. Worldwide, it is estimated that 25 million people identify as transgender. Some undergo hormonal and/or surgical treatment aiming to feminize or masculinize their bodies. Cross-sex hormone treatment for transgender women—individuals assigned as male at birth who identify themselves as women—includes exogenous estrogen and/or progestin administration in combination with anti-androgens, whereas testosterone is used for transgender men—individuals whose natal sex is women but identify themselves as men. Although it is usually rare, hormone-sensitive malignancies may arise, and long-term effects remain unknown. In addition, reconstructive surgeries may include breast augmentation and vaginoplasty (creation of a vagina) for transgender women, and chest masculinization surgery (bilateral mastectomy) and metoidioplasty (lengthening of the clitoris to create a microphallus) or phalloplasty (creation of a phallus) for transgender men. Evidence relating to breast and reproductive tract cancers in the trans population is limited and insufficient to estimate cancer prevalence, and recommendations for screening and preventive care depend on the patients’ hormonal and surgical status. Even less information exists regarding the sub-set of individuals with genetic predisposition for these malignancies. In this review, we aimed to summarize current recommendations for gynecologists and gynecologic oncologists regarding cancer screening and personalized cancer-risk assessment in transgender people.

  • gynecologic surgical procedures
  • miscellaneous
  • genitalia
  • gynecology
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Footnotes

  • Twitter @TriniLabanca

  • Contributors I declare that all authors had made substantial contribution to the present review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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