Gynecologic Oncology Needs for Trans-Masculine and Trans Feminine Persons

Abstract

Purpose of the Review Persons with gender identity that is not congruent with their sex assigned at birth have unique needs in relationship to gynecologic malignancy screening and treatment. Providers of gynecologic oncology care require knowledge of these specific concerns and inclusive practices to avoid under screening and offer evidence-based treatments. This review seeks to collate data on the most common clinical situations gynecologic oncology providers encounter. Recent Findings Transmasculine persons who have a cervix need access to appropriate prevention and screening for cervical cancer but may face obstacles to obtaining this care. Transfeminine persons may develop HPV infection of the neovagina but cancer development rare and prevention is largely unknown. Abnormal uterine bleeding in transmasculine persons either taking gender affirming hormone therapy or not can present a diagnostic challenge which requires careful consideration to rule out malignancy. Concerns about testosterone use and the relationship of androgen receptor to ovarian cancer progression have been raised but conclusive data is lacking. There are no effective strategies for ovarian cancer screening and unnecessary exams should be avoided. Summary Large population based studies are needed to develop evidence based HPV screening guidelines that align with reproductive organ inventories, rather than gender or simply sex assigned at birth. HPV vaccination, utilization of HPV self swab in those for whom pelvic examination is dysphoric and careful evaluation of neovaginal tissue are first steps in reducing HPV related cancer burden. In addition, providers need to carefully evaluate abnormal uterine bleeding in transmasculine persons in gender inclusive ways to adequately detect endometrial pathology. Androgen receptor presence on ovarian cancer remains a biologic concern for transmasculine persons on gender affirming hormone therapy but risk of ovarian cancer appears small. Further long term studies of testosterone hormone therapy in this population are needed.