Transgender and gender-expansive people have the same health concerns as cisgender people (those whose gender identity generally matches the gender assigned for their physical sex), but there are some special considerations.

Helene Hedian, M.D., director of clinical education at the Johns Hopkins Center for Transgender and Gender Expansive Health reviews what transgender people should know about staying healthy.

“Transgender care is health care,” she says. “Like any other patients, transgender people need holistic, preventive primary care, and deserve to get it in a supportive atmosphere from practitioners who earn their trust.”

Some transgender people may not consult health care services because they have had negative experiences with doctors in the past. For the best health possible, people should feel empowered to take an active role by:

• Voicing concerns to practitioners if something doesn’t seem right.
• Asking questions if they are unsure about any information.
• Being forthcoming about any medications and past surgeries, as these may affect treatment plans and preventive care options.

Preventive Care and Screenings

Preventive care and regular screenings are essential for good health. While no one wants to think about developing cancer, high cholesterol, heart disease or bone loss, early detection of these issues can mean more successful treatment.

“Even after gender affirming surgery, any organ you have is one you should take care of,” says Hedian.

Cancer Prevention

Cancer screening saves lives. But routine testing for trans people may not happen if there is confusion around whether or not a person needs to continue Pap tests, breast exams or prostate cancer screening.

Stereotypes and associated discrimination may make it uncomfortable to access and keep up with routine cancer checks. But while it may be unpleasant or difficult for some trans people to bring up these issues with their doctors, scheduling screenings is essential: Early detection can catch cancers while they are still treatable.

With that in mind, it is imperative that anyone with a uterus, cervix, breasts or a prostate gland be offered regular preventive and diagnostic screenings for those organs.

“For instance, if you have breast tissue that has been exposed to estrogen, get mammograms,” Hedian says. “If you have a cervix, be sure to get a Pap test once it’s age-appropriate.

“Gender affirming bottom surgery does not remove a prostate. While taking feminizing hormones may lower the risk of prostate cancer, an individual’s doctor may still recommend a regular exam.”

Bone Health

Hedian recommends a bone density scan (also called a bone densitometry test, or DEXA) for all patients 65 and older to screen for osteoporosis, a weakening of the bones that can result in debilitating fractures or falls. The scan is a simple, painless X-ray.

“Those at high risk should get a DEXA scan at age 50,” she says, noting that factors that increase osteoporosis risk include exposure to glucocorticoid (a type of steroid) medications, premature menopause or having a parent who has had a hip fracture.

For patients who have had their ovaries or testes removed and have not had hormone therapy for five or more years, Hedian recommends a DEXA scan to ensure bone strength, regardless of age.

Cardiovascular Health

To prevent cardiovascular problems, Hedian stresses the basics, advising patients to eat a balanced diet, stay active and do what they can to achieve and maintain a healthy weight.

“Hormones used in gender affirmation can have some effect on cholesterol,” she notes, “so it is a good idea to get levels checked.” Research suggests that some gender affirming hormones can raise or lower cholesterol levels.

Sexual and Reproductive Health

Addressing a patient’s sexual and reproductive health is highly individualized. Hedian says that each person’s anatomy, relationships and sexual practices are all considerations.

Fertility Options

For gender-expansive people who aspire to have biological children, specialized fertility centers can assist, with procedures such as:

• Donor egg procedures
• Donor sperm procedures
• Fertility preservation before medical or surgical transition
• Intrauterine insemination
• Gestational carrying (surrogacy)
• In vitro fertilization (IVF)

Sexually Transmitted Infections (STIs)

Sexual health includes preventing STIs. Common STIs include syphilis, gonorrhea, chlamydia and others.

Aside from sexual abstinence, the best methods to avoid STIs are preventive medicines and vaccines and use of barrier methods such as external condoms, internal condoms or dental dams. Barrier methods play an enormous role in STI prevention, so it is important for transgender and gender-expansive people to feel empowered to make safe sex decisions.

In addition to barrier methods, additional prevention steps may help people avoid these STIs:

• HPV: Vaccines may be recommended to people up to age 45.
• Hepatitis A and hepatitis B: These liver diseases, which can be sexually transmitted, can be prevented with vaccines.
• HIV and AIDS are concerns for anyone who is sexually active. Pre-exposure prophylaxis (PrEP) is a drug or drug combination that can minimize the risk of HIV transmission. Ask your primary care clinician if PrEP may be appropriate for you, or learn more about free PrEP services here or here.

Transgender Safety and Wellness: What to Look Out For

While transgender people share many health concerns with the cis population, there are some special considerations that can affect physical and mental well-being among transgender and gender expansive people.

Violence Against Transgender People

Transgender and gender-expansive people face a disproportionately high risk of physical and sexual violence from dates, family, friends or strangers, much of which is motivated by hate or fear, and stems from a lack of understanding and acceptance.

According to research published in the American Journal of Public Health, transgender individuals experience a dramatically higher prevalence of intimate partner violence (sometimes called domestic violence) compared with cisgender individuals, regardless of sex assigned at birth.

The National Coalition Against Domestic Violence has a hotline and information on services and organizations that are inclusive and supportive of trans survivors.

Workplace Discrimination

According to the National Center for Transgender Equality, 1 in 4 transgender people have lost a job due to bias. Workplace discrimination against transgender people is against the law: Make sure you know your rights as an employee.

Substance Use Disorder

Research shows that transgender and gender expansive people may be more likely than cisgender people to smoke and use alcohol and drugs, putting them at risk for substance use disorder. One reason for this may be chronic stress resulting from stigma, bullying and discrimination toward trans and genderfluid people.

Treatment can help restore mental and physical health, and should be pursued by anyone showing signs of unhealthy or risky drug or alcohol use.

Unmonitored Hormones and Silicone Injections

Transgender people who do not have access to hormones from their doctor may try to get them elsewhere. In proper doses, hormones are safe, but they should be prescribed and monitored by a physician to guard against dangerous side effects.

The use of unmonitored silicone injections is also a health concern for transgender people who may be unable to access professional cosmetic surgery. It is important to avoid these injections, which may contain toxic ingredients and can lead to severe disfigurement and even death.

Staying Stronger Together

The benefits of social connections are essential for optimal health among transgender and gender expansive communities. Reaching out and connecting meaningfully with medical care providers, friends, allies and others can help you build a network of support and transform your well-being. Remember that strength and resilience come from knowing that you are an individual, but never alone.