Transgender and non-binary people and cancer
Transgender and non-binary people and cancer
Learn more about OUTpatients and our work.
On this page
- If you are transgender (trans) and/or non-binary
- Coping with gender dysphoria
- Healthcare for trans and non-binary people
- Getting support
- Cancer screening for trans and non-binary people
- Do gender-affirming treatments cause cancer?
- Symptoms of cancer
- If you need cancer treatment
- Side effects of cancer treatment
- Cancer treatment and gender-affirming hormones
- Radiotherapy and gender-affirming genital surgery
- About our information
OUTpatients has developed this information in partnership with Macmillan. Macmillan is working to improve their information for our community and we are proud to support them in this process.
If you are transgender (trans) and/or non-binary
If you are transgender (trans), non-binary, or both, you may have questions about how this may affect your risk of cancer, or the screening or treatment you may need. Your gender identity should not affect your access to the right healthcare. Your healthcare team should offer you care, support and information that meets your needs. But we know that sometimes trans and non-binary people may face extra challenges in getting the right help.
Trans and non-binary people may also find our page about support for LGBTQ+ people affected by cancer helpful. It includes information about:
- talking to your healthcare team
- coping with negative healthcare experiences
- cancer, sex and fertility
- finding support.
Coping with gender dysphoria
- Join us on a walkthrough of CliniQ, a trans-led clinic in South East London offering a variety of services including cervical screening. In these videos, we follow Octavian as he talks you through what to expect from your cervical screening appointment. Dr Brady, the lead doctor of the clinic, also explains how a sample is taken and gives you tips on how to have a positive experience that can be used at any screening appointment, no matter where you are in the UK.
Healthcare for trans and non-binary people
Your healthcare team should offer you care, support and information that meets your needs. They should treat you as an individual and work with you in a way that respects your privacy and dignity.
Sometimes this means they may ask questions about your gender identity and gender history. This information may be relevant to the healthcare you need, as it is an important part of who you are. Your team may also ask because they want to give the right care and support to you and the people close to you. Tell your team if the questions they ask you do not fit with who you are or how you identify.
You do not have to give your team information about your gender identity and history. But you may find it makes things easier or less stressful. For example, some scans should not be used during pregnancy. If the gender on your NHS record is male and there is a chance you might be pregnant, it is important that the person doing the scan understands this.
Your team should always treat information about your trans status and gender history confidentially. They may share this information with other healthcare professionals, but only when it is needed for your care.
It may also help your healthcare team to know the following things:
- Your name, title and pronouns. You can ask your team to make a note and use these even if they are different from those in your medical records.
- The people who are important to you. Your team needs to understand who supports you and your relationship to them. Tell your team who you give consent for them to talk to about your care.
- What is important to you. This could be anything, such as worries about hair loss or weight changes, or concerns about whether you will be able to continue gender affirming treatments. If there is something you are worried about, talk to your team. You can also tell them if they are offering you the wrong information or support. For example, some cancer treatments can affect your ability to get or make someone pregnant (your fertility). If you want information about this but have not been offered it, ask your team. If they talk to you about it but you do not want or need this information, let them know.
Where will I have tests or treatment
If you need to stay in hospital, your team should talk to you about where you will stay. Hospital wards may be single sex or mixed. Some rooms may have beds for several patients and shared bathrooms. Others may have single rooms with private bathrooms.
Where you stay should give you privacy and keep you safe. If the hospital has single sex wards, you will usually be able to stay in a ward that matches the gender you identify with. Sometimes the hospital will not be able to offer this. For example, it may depend on the type of treatment you need and where it can be given. Tell your team what option or ward you prefer, and what feels comfortable and right for you.
Some health conditions are still often treated in clinics that are gendered. For example, if you have:
- a breast or chest lump, you may be offered tests at a breast clinic
- a problem affecting the vagina or nearby pelvic areas, you may have an appointment at a women’s health clinic
- a problem affecting the prostate, you may be given an appointment at a clinic for men.
These clinics can be difficult to cope with if your gender identity does not reflect the sex you were assigned at birth. If your GP is arranging your appointment, you could ask them to explain this to the clinic. Or you may want to contact the clinic before your appointment and talk to them directly. They may be able to make things easier for you. For example, they may be able to offer an early appointment, when the waiting room is quieter.
Transitioning during cancer
If you are in early stages of your transition when you are diagnosed with cancer, you may have additional questions or concerns you want to discuss. These may be about your social, medical or surgical plans for transition. If you have never talked about your gender identity before, you may not know how to start this conversation with your healthcare team.
If your cancer team need advice about how your cancer care may affect your transition related care, they can contact the Gender Identity Clinic London. They should ask permission to share your information before they do so.
The most important thing is to get the right support for you. You may find the suggestions below helpful.
Getting support
It can help to have people around you who can help or who understand what you are going through:
- Look for NHS Rainbow Badges. If a healthcare professional is wearing an NHS Rainbow Badge , this means they should be open to talking about LGBTQ+ needs and able to offer support. Some healthcare professionals wear rainbow lanyards or other items because they are LGBTQ+ themselves. Others do so to show they support the LGBTQ+ community.
- Take someone you trust with you to appointments. It is usually ok to have a support person with you during appointments and during many types of tests and treatments. Contact the clinic or hospital to check. It can be helpful to have someone else listening and helping you cope with what is happening.
- Talk to others in a similar situation. A support group can be a good way to meet other people, find out how they have coped and talk about what you are going through. We have more about support groups in our information about LGBTQ+ people and cancer treatment.
- Find a supportive LGBTQ+ community. Tranzwiki have a list of groups that offer support for trans and non-binary people. This includes national organisations and local support groups. Search by your area to find out what is available.
If things do not go well
Sometimes healthcare does not work so well. Healthcare professionals may wrongly think they know what you need based on the sex you were assigned at birth or your appearance. They may not ask about or use the right pronouns. At worst, some trans and non-binary people may be treated differently, unfairly or without respect.
It is against the law to discriminate against someone because of their sex or gender reassignment.
Facing discrimination can be stressful and upsetting. It may be especially difficult when you are already dealing with cancer. If you are being treated unfairly, we have more information in the section ‘Will I be treated differently because I’m LGBTQ+’ on our page LGBTQ+ people and cancer treatment.
Cancer screening for trans and non-binary people
The NHS offers routine screening for cervical cancer, breast cancer and bowel cancer. Having screening can reduce your risk of cancer and may save your life.
Cancer screening uses tests to find people who may:
- have cancer – so it can be treated early and effectively
- need treatment – to stop cancer developing.
It is important to know what types of screening are right for your body. CRUK have detailed information about what types of screening trans and non-binary people need. This includes information for people taking gender-affirming hormone treatments or who have had gender-affirming surgery.
Do gender-affirming treatments cause cancer?
There is not a lot of research about gender-affirming treatments and cancer risk. Some treatments may slightly increase or lower your risk of developing some types of cancer. If you see a gender identity specialist, they can help explain what this means in your situation. For example, they may talk to you about any symptoms you should look out for or what screening you should have. If you do not have contact with a general identity specialist, your GP may be able to arrange this for you. The Gender Identity Clinic London may also be able to give specialist advice on cancer risk for trans and non-binary people.
Feminising hormones increase your risk of breast cancer. Your risk is higher than a cisgender man but lower than a cisgender woman. Cisgender means a person’s gender identity matches the sex they were assigned at birth.
You should go for regular breast screening from the age of 50 to 71. Find out more from CRUK about screening for trans and non-binary people.
It is important to know how your breasts normally look and feel, so you can recognise any changes. You can use this CoppaFeel guide to help you learn how to check. Tell your GP if you notice lumps or any changes to your breasts, nipples or armpits. CoppaFeel and OUTpatients (formerly ‘Live Through This’) also have gender-neutral information about chest-checking and changes during transition that may be useful.
Feminising hormones give you a lower risk of prostate cancer than a cisgender man. But it is important to remember that you do still have a prostate, and prostate cancer can develop in this area. There is no screening program for prostate cancer. But tell your GP if you have problems peeing (passing urine). This includes needing to pee suddenly, pain when you pee, or blood in your pee. Prostate Cancer UK have information about prostate cancer for trans women.
There is not a lot of information about cancer risks of masculinising hormone treatment. But it is not thought to increase your risk of cancer.
If you have a vagina, cervix, womb or ovaries, you should tell your GP if you often have a bloated or swollen tummy, or if it does not go away. Also tell your GP if you have unexpected or heavy vaginal bleeding. Macmillan have more detailed information about symptoms of cervical, ovarian and womb cancer.
If you have a cervix, you should go for regular cervical screening. Jo’s Trust have information about cervical screening for trans and non-binary people.
This does not usually remove all the breast tissue. Ask the surgeon who did your operation to explain if you still have breast tissue. If you do, there is a risk of breast cancer. But this risk is less than before your surgery.
It is important to know how your chest normally looks and feels, so you can recognise any changes. You can use the CoppaFeel guide to help you learn how to check. Tell your GP if you notice lumps or any changes to your chest, nipples or armpits.
CoppaFeel and Live Through This also have gender-neutral information about chest-checking and changes during transition that may be useful.
Ask your GP or Gender Identity Clinic about breast screening. If breast cancer runs in your family, you may be offered regular breast screening using an MRI scan. The more commonly used breast screening test (a mammogram) is not usually possible after male chest reconstruction.
If you have had surgery to make a vagina, the risks of cancer in this area are thought to be low. You do not have a cervix and do not need to go for cervical screening (a smear test).
You may still have a vagina, cervix, womb or ovaries. Ask the surgeon who did your surgery if you are not sure.
You should tell your GP if you often have a bloated or swollen tummy, or if it does not go away. Also tell your GP if you have unexpected or heavy vaginal bleeding. We have more detailed information about symptoms of cervical, ovarian and womb cancer.
If you have a cervix, you should go for regular cervical screening. Jo’s Trust have information about cervical screening for trans and non-binary people.
How can I reduce my cancer risk
You can reduce your risk of cancer and improve your general health by making healthy lifestyle choices, such as:
- stopping smoking
- keeping to a healthy weight
- eating and drinking healthily
- being physically active.
The World Cancer Research Fund has more information about making lifestyle changes to reduce your cancer risk.
Symptoms of cancer
Different types of cancer have different symptoms. Many symptoms can be caused by things other than cancer. But it is important to understand your body and be aware of any changes.
There may be parts of your body that you are less comfortable with or feel upset about. Thinking about any symptoms in these areas may be very difficult. Try not to let this stop you from getting checked if you have any changes or symptoms. This includes the following:
Ongoing symptoms – this means a symptom that lasts for more than 3 weeks. This could be a cough that does not go away, a change in bowel function, a mouth ulcer that does not heal, or feeling bloated most days.
Unexplained symptoms – this means a symptom that does not have an obvious cause. For example, you may have a lump or bleeding without any injury.
Unusual symptoms – this means a change in your body that is not normal for you. It could be a change in a cough that you have had for a long time, a change to a mole or an unexplained change to the look or feel of your chest or breasts.
Macmillan have more information about what to look for, and when to get a symptom checked (PDF, 124KB).
You can contact your GP for advice about symptoms. You may find these tips for talking to your GP or practice nurse (PDF, 124KB) helpful. If you go to a gender identity clinic, you can also talk to them. This may be helpful if you find it difficult to talk to your GP. A trans and non-binary friendly sexual health and well-being service may also be able to help – check if this is available in your area on Tranzwiki.
If you need cancer treatment
If you have been diagnosed with cancer, a team of healthcare professionals will work together to plan the treatment they feel is best for you.
Together you make a decision about your treatment plan. Your team needs to understand what is important to you in making this decision. If there is anything you are worried about, tell them so they can help. They may not be aware of things that are difficult for you. By understanding more, they will be able to support you with your decisions.
Sometimes cancer treatment can affect or be affected by gender-affirming treatments. It may be useful for your cancer team to contact your gender identity clinic. You will need to give them permission to do this. If you have not been to a gender identity clinic in the UK, your cancer team can get advice from the Gender Identity Clinic London.
Side effects of cancer treatment
Most people will have some side effects during treatment for cancer. It can depend on the type of cancer and the type of treatment. Your cancer team will explain what to expect and how side effects can be managed.
Some side effects can be upsetting because they cause changes that do not reflect how you identify. For example, hair loss or a change in your weight or body shape may be upsetting if your appearance is an important part of your gender identity. Some treatments might change part of your body that you have worked hard to align with your gender. Other changes and side effects may not be visible, but may still affect how you feel about yourself.
It is important that your team understands how you feel about this as they plan your treatment. You can find more about coping with changes in this information about body image and cancer.
Sometimes surgery to treat cancer is also gender-affirming. Surgery to remove the cancer may remove a body part that you prefer not to have anyway. Again, it is helpful if your team understands how you feel about this, so they can support you and plan your treatment well.
Cancer treatment and gender-affirming hormones
If you take gender-affirming hormones, it is usually fine to keep taking these during cancer treatment.
Your cancer team may talk to you about pausing, stopping or reducing hormone treatment. This is not common, but can be an important thing to talk about with your team.
Reasons for pausing, stopping or reducing hormones may include the following:
- If you have a high risk of blood clots, heart attacks, strokes or diabetes.
- If you are diagnosed with a type of cancer that is sensitive to hormones, such as breast cancer. Your team may suggest pausing your hormone treatment while they do tests to find out more about the type of cancer. In some situations, taking hormones long term may make the cancer more likely to come back after treatment.
It is not always clear how much gender-affirming hormones increase your risk in these situations. Your reasons for taking the hormones are also important and you may feel the benefits of continuing to take them may outweigh the risks for you. Talk to your team about the possible risks and benefits before you make any decisions about changing your hormone treatment.
Radiotherapy and gender-affirming genital surgery
Radiotherapy to the pelvic area (the area between the hips) can cause changes that may affect sexual well-being. Macmillan has more information about pelvic radiotherapy and possible side effects.
If you have had genital surgery to make a new penis or vagina, pelvic radiotherapy may affect these areas. It is important to ask your radiotherapy team what to expect and whether there is a risk of long-term changes. This may depend on the exact area of the pelvis being treated and the way treatment is given. These are some examples:
Pelvic radiotherapy can usually be given in a way that avoids this area. If you also still have a vagina, radiotherapy may cause changes such as dryness, narrowing or bleeding. Your team may suggest using dilators regularly after treatment to prevent vaginal narrowing. This can be helpful if you still need to have cervical screening or want to use the vagina for sex.
Pelvic radiotherapy may narrow the vagina or make the skin more fragile and sensitive. You may need to use dilators more often than you usually do to prevent the vagina closing.
If you are planning to have genital surgery in the future, talk to your team about this before having pelvic radiotherapy. Surgery is not always possible after an area has been treated with radiotherapy. Your team can explain what cancer treatment you need and how this may affect genital surgery in the future.
About our information
This page was developed in partnership with Macmillan. OUTpatients are supporting Macmillan as they work to improve how their cancer information works for LGBTQ+ people. There are areas of their information that they are still working on to make more inclusive. We welcome feedback on any of our information. If you have feedback, please contact [email protected]
Below is a sample of the sources used in our information for people who are LGBTQ+. If you would like more information about the sources we use, please contact [email protected]
Alpert AB and Cicero E. Removing barriers to health care for transgender people with and without cancer. Ethics, Medicine and Public Health. 2020. 13. Available from doi.org/10.1016/j.jemep.2020.100468 (accessed Feb 2022).
Alpert AB, Gampa V, Lytle MC, et al. I’m not putting on that floral gown: Enforcement and resistance of gender expectations for transgender people with cancer. Patient Education and Counselling. 2021. 104 (10): 2552-2558. Available from doi.org/10.1016/j.pec.2021.03.007 (accessed Feb 2022).
De Blok CJM, Dreijerink KMA and den Heijer M. Cancer risk in transgender people. Endocrinol Metab Clin N Am. 2019. 48: 441–452. Available from doi.org/10.1016/j.ecl.2019.02.005 (accessed Feb 2022).
Fish J, Brown J and Williamson I. Coming out in cancer care: Is disclosure of sexual orientation beneficial? Cancer Nursing Practice. 2019. 18(2): 36-41. Available from doi.org/10.1186/s12885-019-5895-7 (accessed Feb 2022).
Fish J, Williamson I and Brown J. Disclosure in lesbian, gay and bisexual cancer care: towards a salutogenic healthcare environment. BMC Cancer. 2019. 19: 678. Available from doi.org/10.1186/s12885-019-5895-7 (accessed Feb 2022).
Kerr L, Fisher CM and Jones T. “I’m not from another planet”: The alienating cancer care experiences of trans and gender-diverse people. Cancer Nursing. 2021. 44(6): E438-E446. DOI: 10.1097/NCC.0000000000000857 (accessed Feb 2022).
Webster R and Drury-Smith H. How can we meet the support needs of LGBT cancer patients in oncology? A systematic review. Radiography. 2021; 27: 633-644. Available from doi.org/10.1016/j.radi.2020.07.009 (accessed Feb 2022).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been approved by Chief Medical Editor, Prof Tim Iveson, Consultant Medical Oncologist.
With thanks to: Dr Alison May Berner, Medical Oncologist; Julie Cain, Clinical Nurse Specialist; Charlotte Etheridge, Clinical Nurse Specialist; Ben Heyworth, Survivorship Network Manager/ Consultant in LGBT and Cancer; Kirstie McEwan, Psychotherapist and Counsellor; Stewart O’Callaghan, Chief Executive, OUTpatients; and Rachael Webster, Radiographer.
Thanks also to the other professionals and the people affected by cancer who reviewed this information.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
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