Journal: Pharmacotherapy
This publication reviews oncologic issues specific to transgender patients, focusing on gender-affirming hormone therapy (GAHT) and cancer risk, screening, and treatment considerations.
Key points:
- Limited GAHT data and cancer risk: Existing data on GAHT and cancer risk in transgender individuals are limited. Based on available studies, GAHT has not been associated with increased risks of cervical, ovarian, testicular, or prostate cancer.
- Estrogen therapy and breast cancer risk: Estrogen therapy in transgender women warrants additional caution in those with elevated breast cancer risk (e.g., strong family history or other risk factors). Risk–benefit discussions and individualized decision-making are emphasized.
- Organ-based cancer screening: Cancer screening should be based on organs present, not gender identity alone. Transgender patients need screening appropriate to retained tissues (e.g., prostate, cervix, breast, ovaries/testes), even when these do not align with their affirmed gender.
- Clinical calculations and sex modifiers: In oncologic care, clinical calculations that use sex modifiers (e.g., chemotherapy dosing, renal function estimates) can be challenging. Duration of hormone therapy is proposed as one factor to help decide whether to use sex assigned at birth or affirmed gender in such calculations.
- Education and gender-affirming care: The article underscores the importance of education, cultural competence, and gender-affirming practices so that oncology care for transgender people is both clinically effective and respectful of their identity.