What trans and nonbinary folks need to know about breast cancer.

by Sam Skye, Oct 1, 2024

Image of cells

Breast cancer doesn’t only affect cisgender women. Transgender men, women, and nonbinary individuals also face unique risks. Awareness is increasing, but challenges to accessing good information, screening, and care remain. Here’s what you need to know:

Breast Cancer Risk in Transgender Individuals

Transgender Men and Nonbinary People Assigned Female at Birth (AFAB):

  • Risk Overview:

    • Everyone has breast tissue, which means transgender men and AFAB nonbinary individuals are still at risk, even after chest surgery.

    • Risk is lower than for cisgender women, but not zero. Surgery often leaves some glandular tissue that can develop cancer.

  • Screening Needs:

    • Routine screenings are essential. There is no consensus on screening recommendations for post-top surgery patients. Still, the U.S. Preventive Services Task Force recommends that AFAB folks follow the same screening guidelines as used by cisgender women.

    • A digital breast tomosynthesis (DBT, also called a 3D mammogram) or ultrasound may be used to screen folks after top surgery.

    • Testosterone therapy’s impact on breast cancer risk is still being studied. Discuss individual risk factors with your healthcare provider.

Nurse and patient during mammogram (image credit: healthline)

Transgender Women and Nonbinary People Assigned Male at Birth (AMAB):

  • Risk Overview:

    • Taking estrogen (HRT) increases breast cancer risk compared to AMAB individuals not on HRT.

    • Risk is generally lower than cisgender women but increases the longer one has been on estrogen, especially after 5–10 years.

Breast Cancer Screening Guidelines

  • AFAB Individuals:

    • Without Chest Surgery: Regular mammograms starting at age 50, especially if there are other risk factors (e.g., family history).

    • With Chest Surgery: Talk to your provider about remaining tissue and appropriate screenings (physical exams, mammograms, or ultrasounds).

  • AMAB Individuals:

    • If on estrogen therapy for at least five years, start mammograms at age 50 and repeat every two years.

    • Discuss a personalized screening approach with your provider.

Addressing Barriers to Care

  • Challenges: Discrimination, provider knowledge gaps, and anxiety around gendered spaces can discourage screenings.

  • Action:

    • Seek out affirming, knowledgeable providers.

    • Discussing personal medical history, hormone use, family history of breast cancer, and any changes in chest tissue can help determine an individualized screening plan.

    • Genetic counseling for transgender people with a family history of breast cancer may help.

Empowerment Through Awareness

Awareness and education can empower transgender individuals to take charge of their breast health. Know your risks, talk to providers, and get the screenings you need.

Disclaimer: This article is based on information from the listed sources and is intended for educational purposes only. It should not be considered medical advice or a substitute for professional guidance. Always consult a healthcare provider for personalized cancer screening and care advice.

Sources:

  1. Breastcancer.org – Breast Cancer Screening for Transgender and Nonbinary People

  2. Clue – What Trans Men and Nonbinary People Need to Know About Breast Cancer

  3. Cedars-Sinai – What Transgender People Need to Know About Breast Cancer Risk and Screening

Announcing Euphoria Week:

Free Week-Long Celebration of Queer Joy and Wellness

Full Spectrum Therapy (FST) is thrilled to announce Euphoria Week—a week-long series of free events dedicated to celebrating queer joy and wellness. This exciting event, open to all members of the LGBTQ+ community and allies, is designed to uplift, inspire, and connect. Each day offers a variety of activities that highlight the beauty and diversity of our community. Join us as we celebrate, learn, and create together!

ALL EVENTS ARE 100% FREE

(donations for Gaza relief accepted)

Event Highlights

Chest Binding Workshops/Fittings

  • Learn safe binding practices and get fitted with the perfect chest binder. Our knowledgeable facilitators will provide guidance and resources to ensure comfort and safety.

Free Gender Affirming Clothing Closet

  • Explore our clothing closet stocked with gender-affirming attire. Find outfits that make you feel confident and authentic, all free of charge.

Gender Wonderful Beach Takeover

  • Spend a day at the beach with fellow LGBTQ+ individuals. Enjoy the sun, sand, and sea in a supportive and affirming environment.

Giant Bubble Making Class

  • Embrace your inner child with our giant bubble making class. This fun and whimsical activity is perfect for all ages and a great way to spread joy.

LGBTQ+ Knitting Workshop & Craft Night

  • Join us for a cozy evening of knitting and crafting. Whether you're a seasoned knitter or a beginner, this workshop is a great way to relax and connect with others.

Live Makeup Tutorials (Femme Inspired & Masc Inspired)

  • Discover new makeup techniques with our live tutorials. Whether you’re looking for femme-inspired or masc-inspired looks, our talented makeup artists will provide tips and tricks to enhance your beauty.

Open Art Studio

  • Express yourself creatively in our open art studio. All supplies are provided, so you can paint, draw, and create to your heart's content.

Daily Queer Joy Meditation

  • Start each day with a meditation session focused on queer joy. These guided sessions are designed to center, ground, and uplift, providing a peaceful start to your day.

Wig Workshops

  • Explore the world of wigs with our hands-on workshops. Learn styling tips and techniques to make your wig look fabulous and fit comfortably.

Why Attend?

Euphoria Week is more than just a series of events; it's a celebration of our community's resilience, creativity, and joy. Each activity is designed to foster connection, self-expression, and well-being. Whether you're looking to learn a new skill, find support, or simply have fun, Euphoria Week offers something for everyone.

Join Us!

Mark your calendars and get ready to celebrate with Full Spectrum Therapy. All events are free and open to the public, so bring your friends, family, and allies. Let's come together to create unforgettable memories and celebrate the vibrant spirit of the LGBTQ+ community.

Registration Starts July 1st!

For more information and to express interest in specific events, visit euphoriaweek.com. We can't wait to celebrate with you!

Euphoria Week—where every day is a celebration of queer joy.

Addressing Recent Rumors and Media

Knee-jerk call outs say: those who cause harm or mess up or disagree with us cannot change and cannot belong. They must be eradicated. The bad things in the world cannot change, we must disappear the bad until there is only good left.
But one layer under that, what I hear is:
We cannot change.
We do not believe we can create compelling pathways from being harm doers to being healed, to growing.
We do not believe we can hold the complexity of a gray situation.
We do not believe in our own complexity.
We do not believe we can navigate conflict and struggle in principled ways.
We can only handle binary thinking: good/bad, innocent/guilty, angel/abuser, black/white, etc.”

― Adrienne Maree Brown, We Will Not Cancel Us: And Other Dreams of Transformative Justice

If you have questions about recent things you’ve read or heard about FST, we answered them here: FST FAQ Our other statement can be seen here.

“The call outs generally share one side of what’s happened and then call for immediate consequences. And within a day, the call out is everywhere, the cycle of blame and shame activated, and whoever was called out has begun being publicly punished. Sometimes, there are consequences—loss of job, community, reputation, platform. Sometimes there is just derision, and calls for disappearance. The details of the offense blur or compound as others add their own opinions and experiences to the story.”
― Adrienne Maree Brown, We Will Not Cancel Us: And Other Dreams of Transformative Justice

Dearest Gentle reader,

Despite facing a smear campaign following the termination of a former staffer for serious ethical violations, FST remains steadfast and resilient. Our dedication to transparency and professional ethics ensures that we continue to provide high-quality care and maintain our reputation for excellence.

Full Spectrum Therapy remains committed to excellence in mental health care, professional development, and community support, continually striving to create a more inclusive and supportive environment for all.

Full Spectrum Therapy is more than just a clinic; it's a community dedicated to making a difference. We invite you to join us on our journey, whether as a client, intern, or partner. Together, we can continue to break down barriers and ensure that every individual has access to the affirming mental health care they deserve.

Let's build a brighter, more inclusive future together.

Sincerely,

Sam Skye, LPC

Risks of Estrogen Hormone Therapy

This article is part of a series on the impacts of hormone replacement therapy (HRT), designed to help our clients (and others!) prepare for possible changes they may experience as they begin their hormone journeys.

It wouldn’t be responsible to talk about hormone replacement therapy (HRT) without discussing the risks and benefits of treatment. All medications come with risks, but there are many myths about the health risks of estrogen hormone treatment. Therefore, we have also included some reassuring facts that may help alleviate those concerns.

Click here to read the full article by Dr. Maddie Deutsch, Associate Professor of Clinical Family & Community Medicine at the University of California – San Francisco (UCSF), and Medical Director for UCSF Transgender Care.

Risks

  • The biggest increase in risk when taking estrogen occurs when it is combined with cigarette smoking. In this case, there is a notable increased risk of blood clots and a likely increase in strokes and heart attacks. These risks can be mitigated by changing the mode of estrogen delivery from injection to patch or other topical form.

  • In those who don’t smoke, hormone therapy may still correlate with a slight increase in the risk of blood clots, heart attacks, strokes, diabetes, and cancer. The risks are higher for those with co-existing health conditions and those who start hormone therapy after age 50. The increase in risk may be offset by quality-of-life improvements and reductions in stress levels.

  • Since there is not a lot of research on the use of estrogen for feminizing treatment, there may be other unknown risks, especially for those who have used estrogen for many years.

Rare Risks

  • While gender-affirming hormone therapy usually results in an improvement in mood, some people may experience mood swings or a worsening of anxiety, depression, or other mental health conditions as a result of second puberty. If you have any mental health conditions, you may choose to remain in discussion with a mental health provider as you begin hormone therapy.

  • Some medical conditions, such as autoimmune disorders and migraines, have a hormonal component and thus may be impacted by gender-affirming hormone therapy, though research is lacking. Ask your medical provider if you have further questions about the risks, health monitoring needs, and other long-term considerations when taking hormone therapy.

  • Modern, healthy approaches to estrogen therapy have no risk of causing liver injury. However, in rare cases, the flow of bile from the liver through the gallbladder may be slowed as a result of hormone therapy, which can lead to an increased risk of gallstones.

Reassurances

  • It is possible that the risk of prostate cancer decreases with hormone therapy, but there is not enough research to know for sure.

  • The risk of breast cancer may increase slightly with hormone use, but will still be much lower than the risk in a non-transgender female.

  • For those over 50, it might be appropriate to use testosterone blockers only, reducing or even eliminating the dose of estrogen (thus removing the health risks that accompany estrogen use for individuals of this age). Since most non-transgender women go through menopause with declining estrogen levels at age 50, this approach is similar to the natural female life course and may be of particular value in those with other health risks.

  • For those who have had an orchiectomy or vaginoplasty, you will be able to stop taking testosterone blockers and may be able to take a lower dose of hormones, but should remain on at least a minimal dose of hormones until age 50. This will help prevent a potentially severe weakening of the bones, otherwise known as osteoporosis, which can result in serious and disabling bone fractures.

  • Many of the effects of hormone therapy are reversible if you stop taking hormones. The degree to which they can be reversed depends on how long you have taken them. Breast growth and infertility may not be reversible.

Risks of Testosterone Hormone Therapy

It wouldn’t be responsible to talk about hormone replacement therapy (HRT) without discussing the risks and benefits of treatment. All medications come with risks, but there are many myths about the health risks that come with testosterone treatment. Therefore, we have also included some reassuring facts that may help alleviate those concerns.

Click here to read the full article written by Dr. Maddie Deutsch, Associate Professor of Clinical Family & Community Medicine at the University of California – San Francisco (UCSF), and Medical Director for UCSF Transgender Care.

Risks

  • Most people using masculinizing testosterone therapy will experience at least a small amount of acne. Some may experience more advanced acne. Often, this acne responds to typical over-the-counter treatments, but in some cases, prescription medication may be required. Acne usually peaks within the first year of treatment and then begins to improve.

  • While gender-affirming hormone therapy usually improves mood, some people may experience mood swings or a worsening of anxiety, depression, or other mental health conditions due to the shifts associated with starting a second puberty. If you have any mental health conditions, you should remain in discussion with a mental health provider as you begin hormone therapy.

  • Because testosterone typically causes menstruation to stop, you may have or develop an underlying fertility condition you are unaware of, which may impact your future ability to conceive and carry a pregnancy. While many transgender people have successfully given birth, long-term testosterone use may impact egg quality and quantity— especially for those over age 35, who may have struggled to achieve a pregnancy even without hormone therapy.

Rare Risks

  • If a testosterone dose is too high for the body’s metabolism, a high hematocrit count (thickening of the blood) can result. This can cause a stroke, heart attack, or other serious conditions. This can be prevented through blood tests to monitor blood and hormone levels, ensuring appropriate dosage.

  • As with anyone with a uterus, you may still experience issues with reproductive organs, such as fibroids, blocked fallopian tubes, or an imbalance in the uterine lining. The likelihood of these challenges is not increased by testosterone use, but be sure to report any return of bleeding or spotting to your provider, who may request an ultrasound or other tests. Missing a dose or changing your dose can sometimes result in bleeding or spotting.

  • For those who have their ovaries removed, osteoporosis can occur if testosterone levels are too high. Thus, it is important to remain on at least a low dose of hormones post-op until at least age 50.

  • Anecdotal evidence suggests that some medical conditions, such as autoimmune conditions (which can sometimes improve or worsen with hormone shifts) and migraines (which often have a hormonal component), may be impacted by gender-affirming hormone therapy, though research is lacking. Ask your medical provider if you have further questions about the risks, health monitoring needs, and other long-term considerations when taking hormone therapy.

Reassurances

  • Overall, cisgender men have higher rates of cholesterol-related disorders and heart disease than cisgender women. However, the research on the risk of heart disease and strokes in transgender men suggests that risk does not increase once testosterone is begun. The risk of other medical conditions, such as diabetes, may be slightly increased by testosterone therapy, but actual research supporting these claims is limited.

  • It does not appear that testosterone increases the risk of cancer in the uterus, ovaries, or breasts. Because not all breast tissue is removed during masculinizing chest surgery, otherwise known as top surgery, there is a theoretical risk that breast cancer could develop in the remaining tissue, but these rates are certainly lower than breast cancer risks in cisgender women.

  • There is no evidence that testosterone therapy plays any role in HPV infection or cervical cancer. Cervical cancer is caused by an infection with the human papillomavirus, or HPV (which is transmitted sexually).

  • Fortunately, since you do not have a prostate, you have no risk of prostate cancer, and there is no need to screen for this condition.

  • Some of the effects of testosterone hormone therapy are reversible if you stop taking it. The degree to which they can be reversed depends on how long you have taken testosterone. In general, clitoral growth, facial hair growth, voice changes, and male-pattern baldness are not reversible.

Emotional Changes from Testosterone Hormone Therapy

During transition, many people are eager for hormonal changes to take place rapidly- understandably so. Most people anticipate physical changes from hormones, but it is just as important to prepare for the emotional changes that may occur.

Puberty is a roller coaster of emotions, and the second puberty you will experience during your transition is no exception.

Read more