Download PDF
Semin Reprod Med 2017; 35(05): 426-433
DOI: 10.1055/s-0037-1604457
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preventive Health for Transgender Men and Women

Katherine L. Imborek
1   Department of Family Medicine, University of Iowa Health Care, Iowa City, Iowa
,
Elizabeth M. Graf
2   Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa Health Care, Iowa City, Iowa
,
Kaitlyn McCune
3   Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, North Carolina
› Author Affiliations
Further Information

Publication History

Publication Date:
26 October 2017 (online)

    Permissions and Reprints

Abstract

Transgender men and women experience an incongruity between their assigned sex at birth and their identified gender. Gender dysphoria is defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as clinically significant distress or impairment resulting from misalignment in assigned and experienced gender. Transgender people have a history of negative experiences in health care and efforts should be made to create a welcoming environment through staff training, gender neutral restrooms, and gender inclusive electronic medical record systems. Transgender men and women face unique preventive health concerns in areas of metabolic screening, cancer screening, immunizations, and anticipatory guidance secondary to cross-sex hormone therapy, gender confirming surgical procedures, and certain high-risk behaviors. Here, the available data are reviewed and suggested best practices are outlined to optimize the preventive health for this patient population.

Keywords

transgender - gender dysphoria - preventive health
 

  • References

  • 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013
    Search in Google Scholar
  • 2 Feldman J, Safer J. Hormone therapy in adults: suggested revisions to the sixth version of the standards of care. Int J Transgenderism 2009; 11 (03) 146-182
    CrossrefPubMedSearch in Google Scholar
  • 3 Unger C. Update on gender-affirming treatment for the transgender woman. Semin Reprod Med 2017; 35: 442-447
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. Executive summary of the report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality. 2015 . Available at: http://www.transequality.org/sites/default/files/docs/usts/Executive%20Summary%20-%20FINAL%201.6.17.pdf . Accessed July 26, 2017
    PubMedSearch in Google Scholar
  • 5 Cook S, Gunter K, Lopez F. Establishing effective health care partnerships with sexual and gender minority patients: recommendations for obstetrician gynecologists. Semin Reprod Med 2017; 35: 397-407
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Human Rights Campaign Foundation. Anti-transgender legislation spreads nationwide, bills targeting transgender children surge. 2016 . Available at: http://assets.hrc.org//files/assets/resources/HRC-Anti-Trans-Issue-Brief-FINAL-REV2.pdf?_ga=1.46151343.98985811.1456593447 . Accessed July 26, 2017
    PubMedSearch in Google Scholar
  • 7 Deutsch MB, Green J, Keatley J, Mayer G, Hastings J, Hall AM. ; World Professional Association for Transgender Health EMR Working Group. Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group. J Am Med Inform Assoc 2013; 20 (04) 700-703
    CrossrefPubMedSearch in Google Scholar
  • 8 Goff Jr DC, Lloyd-Jones DM, Bennett G. , et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63 (25, Pt B): 2935-2959
    CrossrefPubMedSearch in Google Scholar
  • 9 Bibbins-Domingo K. ; U.S. Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2016; 164 (12) 836-845
    CrossrefPubMedSearch in Google Scholar
  • 10 Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People; 2nd edition. Deutsch MB, ed. June 2016. Available at: www.transhealth.ucsf.edu/guidelines
    PubMed
  • 11 Wierckx K, Elaut E, Declercq E. , et al. Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study. Eur J Endocrinol 2013; 169 (04) 471-478
    CrossrefPubMedSearch in Google Scholar
  • 12 Asscheman H, Giltay EJ, Megens JA, de Ronde WP, van Trotsenburg MA, Gooren LJ. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol 2011; 164 (04) 635-642
    CrossrefPubMedSearch in Google Scholar
  • 13 Vigen R, O'Donnell CI, Barón AE. , et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA 2013; 310 (17) 1829-1836
    CrossrefPubMedSearch in Google Scholar
  • 14 Sharma R, Oni OA, Gupta K. , et al. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J 2015; 36 (40) 2706-2715
    CrossrefPubMedSearch in Google Scholar
  • 15 Cheetham TC, An J, Jacobsen SJ. , et al. Association of testosterone replacement with cardiovascular outcomes among men with androgen deficiency. JAMA Intern Med 2017; 177 (04) 491-499
    CrossrefPubMedSearch in Google Scholar
  • 16 Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA. , et al; Endocrine Society. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009; 94 (09) 3132-3154
    CrossrefPubMedSearch in Google Scholar
  • 17 Rossouw JE, Anderson GL, Prentice RL. , et al; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 2002; 288 (03) 321-333
    CrossrefPubMedSearch in Google Scholar
  • 18 Anderson GL, Limacher M, Assaf AR. , et al; Women's Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004; 291 (14) 1701-1712
    CrossrefPubMedSearch in Google Scholar
  • 19 Vehkavaara S, Silveira A, Hakala-Ala-Pietilä T. , et al. Effects of oral and transdermal estrogen replacement therapy on markers of coagulation, fibrinolysis, inflammation and serum lipids and lipoproteins in postmenopausal women. Thromb Haemost 2001; 85 (04) 619-625
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Scarabin PY, Oger E, Plu-Bureau G. ; EStrogen and THromboEmbolism Risk Study Group. Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet 2003; 362 (9382): 428-432
    CrossrefPubMedSearch in Google Scholar
  • 21 Feldman J, Spencer K. Medical and surgical management of the transgender patient: what the primary care clinician needs to know. In: Makadon HJ, Mayer KH, Potter J, Goldhammer H. , eds. Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. 2nd ed. Philadelphia, PA: American College of Physicians; 2016: 479-516
    Search in Google Scholar
  • 22 James PA, Oparil S, Carter BL. , et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311 (05) 507-520
    CrossrefPubMedSearch in Google Scholar
  • 23 Baba T, Endo T, Honnma H. , et al. Association between polycystic ovary syndrome and female-to-male transsexuality. Hum Reprod 2007; 22 (04) 1011-1016
    CrossrefPubMedSearch in Google Scholar
  • 24 Mueller A, Gooren LJ, Naton-Schötz S, Cupisti S, Beckmann MW, Dittrich R. Prevalence of polycystic ovary syndrome and hyperandrogenemia in female-to-male transsexuals. J Clin Endocrinol Metab 2008; 93 (04) 1408-1411
    CrossrefPubMedSearch in Google Scholar
  • 25 Gooren LJ, Giltay EJ, Bunck MC. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab 2008; 93 (01) 19-25
    CrossrefPubMedSearch in Google Scholar
  • 26 Siu AL. ; U S Preventive Services Task Force. Screening for abnormal blood glucose and type 2 diabetes mellitus: U.S. preventive services task force recommendation statement. Ann Intern Med 2015; 163 (11) 861-868
    CrossrefPubMedSearch in Google Scholar
  • 27 Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999; 22 (01) 141-146
    CrossrefPubMedSearch in Google Scholar
  • 28 Bibbins-Domingo K, Grossman DC, Curry SJ. , et al; US Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults. JAMA 2016; 316 (19) 1997-2007
    CrossrefPubMedSearch in Google Scholar
  • 29 Ott J, Aust S, Promberger R, Huber JC, Kaufmann U. Cross-sex hormone therapy alters the serum lipid profile: a retrospective cohort study in 169 transsexuals. J Sex Med 2011; 8 (08) 2361-2369
    CrossrefPubMedSearch in Google Scholar
  • 30 Sanada M, Tsuda M, Kodama I, Sakashita T, Nakagawa H, Ohama K. Substitution of transdermal estradiol during oral estrogen-progestin therapy in postmenopausal women: effects on hypertriglyceridemia. Menopause 2004; 11 (03) 331-336
    CrossrefPubMedSearch in Google Scholar
  • 31 Cosman F, de Beur SJ, LeBoff MS. , et al; National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 2014; 25 (10) 2359-2381
    CrossrefPubMedSearch in Google Scholar
  • 32 Saslow D, Solomon D, Lawson HW. , et al; ACS-ASCCP-ASCP Cervical Cancer Guideline Committee. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 2012; 62 (03) 147-172
    CrossrefPubMedSearch in Google Scholar
  • 33 Moyer VA. ; U.S. Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012; 156 (12) 880-891 , W312
    CrossrefPubMedSearch in Google Scholar
  • 34 Potter J, Peitzmeier SM, Bernstein I. , et al. Cervical cancer screening for patients on the female-to-male spectrum: a narrative review and guide for clinicians. J Gen Intern Med 2015; 30 (12) 1857-1864
    CrossrefPubMedSearch in Google Scholar
  • 35 Peitzmeier SM, Reisner SL, Harigopal P, Potter J. Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: implications for cervical cancer screening. J Gen Intern Med 2014; 29 (05) 778-784
    CrossrefPubMedSearch in Google Scholar
  • 36 Peitzmeier SM, Khullar K, Reisner SL, Potter J. Pap test use is lower among female-to-male patients than non-transgender women. Am J Prev Med 2014; 47 (06) 808-812
    CrossrefPubMedSearch in Google Scholar
  • 37 van der Sluis WB, Buncamper ME, Bouman MB. , et al. Prevalence of neovaginal high-risk human papillomavirus among transgender women in the Netherlands. Sex Transm Dis 2016; 43 (08) 503-505
    CrossrefPubMedSearch in Google Scholar
  • 38 Siu AL. ; U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2016; 164 (04) 279-296
    CrossrefPubMedSearch in Google Scholar
  • 39 American College of Obstetricians-Gynecologists. Practice bulletin no. 122: Breast cancer screening. Obstet Gynecol 2011; 118 (2, Pt 1): 372-382
    CrossrefPubMedSearch in Google Scholar
  • 40 Burcombe RJ, Makris A, Pittam M, Finer N. Breast cancer after bilateral subcutaneous mastectomy in a female-to-male trans-sexual. Breast 2003; 12 (04) 290-293
    CrossrefPubMedSearch in Google Scholar
  • 41 Miglioretti DL, Rutter CM, Geller BM. , et al. Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA 2004; 291 (04) 442-450
    CrossrefPubMedSearch in Google Scholar
  • 42 Deutsch M, Radix A, Wesp L. Breast cancer screening, management, and a review of case study literature in transgender populations. Semin Reprod Med 2017; 35: 434-441
    Thieme ConnectPubMedSearch in Google Scholar
  • 43 Practice Bulletin No. 149: Endometrial cancer. Obstet Gynecol 2015; 125 (04) 1006-1026
    CrossrefPubMedSearch in Google Scholar
  • 44 American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol 2011; 117 (03) 742-746
    CrossrefPubMedSearch in Google Scholar
  • 45 Bibbins-Domingo K, Grossman DC, Curry SJ. , et al; US Preventive Services Task Force. Screening for gynecologic conditions with pelvic examination: US Preventive Services Task Force Recommendation Statement. JAMA 2017; 317 (09) 947-953
    CrossrefPubMedSearch in Google Scholar
  • 46 Centers for Disease Control and Prevention. HPV and Cancer. 2016 . Available at: https://www.cdc.gov/cancer/hpv/index.htm . Accessed July 26, 2017
    PubMedSearch in Google Scholar
  • 47 Palefsky JM, Holly EA, Efirdc JT. , et al. Anal intraepithelial neoplasia in the highly active antiretroviral therapy era among HIV-positive men who have sex with men. AIDS 2005; 19 (13) 1407-1414
    CrossrefPubMedSearch in Google Scholar
  • 48 Daling JR, Madeleine MM, Johnson LG. , et al. Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer 2004; 101 (02) 270-280
    CrossrefPubMedSearch in Google Scholar
  • 49 U.S. Department of Veterans Affairs. HIV/AIDS for Healthcare Providers: Anal Dysplasia: Primary Care of Veterans with HIV. October 28, 2011. Available at: https://www.hiv.va.gov/provider/manual-primary-care/anal-dysplasia.asp . Accessed July 26, 2017
    PubMed
  • 50 New York State Guideline Recommendations on Anal Pap Smears. Albany, NY: New York State Department of Health; July 2007. Available at: http://www.natap.org/2010/HIV/032510_01.htm . Accessed July 26, 2017
    PubMed
  • 51 Eckstrand KL, Potter J, Edmiston EK. Obstetric and gynecologic care for individuals who are LGBT. In: Eckstrand KL, Ehrenfeld J. , eds. Lesbian, Gay, Bisexual, and Transgender Healthcare: A Clinical Guide to Preventive, Primary and Specialist Care. Switzerland: Springer; 2016: 324
    Search in Google Scholar
  • 52 Steele SR, Varma MG, Melton GB, Ross HM, Rafferty JF, Buie WD. ; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for anal squamous neoplasms. Dis Colon Rectum 2012; 55 (07) 735-749
    CrossrefPubMedSearch in Google Scholar
  • 53 Qaseem A, Barry MJ, Denberg TD, Owens DK, Shekelle P. ; Clinical Guidelines Committee of the American College of Physicians. Screening for prostate cancer: a guidance statement from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2013; 158 (10) 761-769
    CrossrefPubMedSearch in Google Scholar
  • 54 Jin B, Turner L, Walters WA, Handelsman DJ. The effects of chronic high dose androgen or estrogen treatment on the human prostate [corrected]. J Clin Endocrinol Metab 1996; 81 (12) 4290-4295
    PubMedSearch in Google Scholar
  • 55 Centers for Disease Control and Prevention. Recommended Immunization Schedule for Adults. Atlanta, GA; February 2017. Available at: https://www.cdc.gov/vaccines/schedules/hcp/adult.html . Accessed July 26, 2017
    PubMed
  • 56 Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination - updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016; 65 (49) 1405-1408
    CrossrefPubMedSearch in Google Scholar
  • 57 New York State Department of Health. Health Advisory: NYSDOH Meningococcal Vaccine Recommendations for HIV-Infected Individuals and Those at High Risk of HIV Infection. Albany, NY; October 2016. Available at: https://www.health.ny.gov/diseases/aids/general/prep/docs/health_advisory_10-2016.pdf . Accessed July 26, 2017
    PubMed
  • 58 Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol 2014; 124 (06) 1120-1127
    CrossrefPubMedSearch in Google Scholar
  • 59 Cipres D, Seidman D, Cloniger III C, Nova C, O'Shea A, Obedin-Maliver J. Contraceptive use and pregnancy intentions among transgender men presenting to a clinic for sex workers and their families in San Francisco. Contraception 2017; 95 (02) 186-189
    CrossrefPubMedSearch in Google Scholar
  • 60 Daskalakis DC, Radix A, Mayer G. Sexual health of LGBTQ people. In: Makadon HJ, Mayer KH, Potter J, Goldhammer H. , eds. Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. 2nd ed. Philadelphia, PA: American College of Physicians; 2016: 479-516
    Search in Google Scholar
  • 61 Centers for Disease Control and Prevention. 2015 Sexually Transmitted Diseases Treatment Guide: Special populations. Atlanta, GA; 2015 . Available at: https://www.cdc.gov/std/tg2015/specialpops.htm . Accessed July 26, 2017
    PubMedSearch in Google Scholar
  • 62 Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N. ; HIV/AIDS Prevention Research Synthesis Team. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav 2008; 12 (01) 1-17
    PubMedSearch in Google Scholar
  • 63 Fenway Health. The Medical Care of Transgender Persons. Boston, MA; 2015 . Available at: http://www.lgbthealtheducation.org/wp-content/uploads/COM-2245-The-Medical-Care-of-Transgender-Persons.pdf . Accessed July 26, 2017
    PubMedSearch in Google Scholar
  • 64 Grant RM, Lama JR, Anderson PL. , et al; iPrEx Study Team. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363 (27) 2587-2599
    CrossrefPubMedSearch in Google Scholar
  • 65 US Public Health Service. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States, 2014: A Clinical Practice Guideline. Available at: https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf . Accessed July 26, 2017
    PubMed
  • 66 World Health Organization. Guidance on Pre-Exposure Oral Prophylaxis (PrEP) for Serodiscordant Couples, Men and Transgender Women Who Have Sex with Men at High Risk of HIV: Recommendations for Use in the Context of Demonstration Projects. Geneva: World Health Organization; 2012
    Search in Google Scholar