Transgender Health and Wellness Recommendations

Health guidelines for transgender people are unfortunately an under-researched topic. Most existing guidelines are extremely binary and based on sex assigned at birth, which comprises anatomy, body composition, and hormones. The research doesn’t offer much guidance for non-binary or intersex individuals. Knowing whether to follow existing female or male guidelines can therefore be confusing and often requires the guidance and support of a health care provider.

At the same time, many health guidelines don’t necessarily need to be correlated with assigned sex. More often, height and weight are more apt breakdowns for health guidelines. This means that health guidelines aren’t always accurate even for cisgender people. This emphasizes the importance of working with a health care provider to help you get accurate information about your individual health. 

What influences transgender healthcare? 

Your risk of developing certain health conditions and what healthcare will look like for you often depends on the sex you were assigned at birth—assigned female at birth (AFAB) or assigned male at birth (AMAB)—and the type(s) of gender affirming care (GAC) you receive. As such, your recommendations will likely align with sex you were assigned at birth, unless you’ve had any organs removed or are on gender affirming hormone therapy (GAHT) that impacts the function of these organs. Because your use of GAHT and surgeries may be specific to your unique goals and needs, it’s recommended you work with a health care provider to help you assess your particular risk for certain conditions.

What are guidelines for people AFAB?

As long as you currently have organs that are associated with bodies assigned female at birth (AFAB), you can develop medical conditions in any of these organs, including the cervix, ovaries, uterus, and vagina. 

You may also be more likely to develop certain conditions that are more common in AFAB people, like: 

• Arthritis 
• Heart disease 
• Urinary tract infections (UTIs) 
• Multiple sclerosis (MS) 

If you have any predispositions for these conditions, getting regularly checked can help you stay on top of your health. This might include regular gynecological exams to test for STIs, cancer, and other health conditions. That said, these types of exams, which focus on AFAB organs, might activate feelings of gender dysphoria. If you feel uncomfortable with having a pelvic exam done, you might consider speaking with a health care provider to seek other options, including having your ovaries, uterus, and cervix removed.

What are guidelines for people AMAB?

If you currently have organs that are associated with AMAB bodies that haven’t been removed, you might be in danger of getting conditions that affect your penis, testicles, and prostate. AMAB individuals might also be at higher risk of developing: 

• Amyotrophic Lateral Sclerosis (ALS) 
• Kidney stones 
• Pancreatitis 
• Pancreatic cancer 
• Parkinson’s disease 

For AMAB individuals, it might be a good idea to screen for conditions involving reproductive organ, including getting penile, testicular, and prostate exams. It’s generally recommended, for example, to get a prostate exam every year, once you turn 50 years old, as a way to monitor your health and screen for cancer. If you feel uncomfortable with having any of these exams done, you might consider speaking with a health care provider to seek other options, including having your penis, testicles, or prostate removed.

What are intersex guidelines?

If you’re intersex, it's possible that you might have a higher chance of developing conditions like: 

• Congenital adrenal hyperplasia 
• Hypospadias 
• Klinefelter syndrome 
• Mayer-Rokitansky-Küster-Hauser Syndrome
• Swyer syndrome

Working with a health care provider to go over your reproductive health might be helpful in figuring out how best to take care of your health. 

What are some specific health and wellness considerations for all transgender people? 

Breast cancer risk 

Anyone with breast tissue can get breast cancer; this means all humans can get breast cancer, although AFAB individuals are usually at a higher risk. Being aware about breast cancer risk is especially important for those taking hormone therapy; those who have had top surgery, surgery to remove the uterus (hysterectomy), or the ovaries (oophorectomy); and those with BRCA1 or BRCA2 gene mutations and those with family history. 

1. Hormone therapy: If your gender affirming hormone therapy (GAHT) involves taking estrogen, you’re at higher risk for developing breast cancer. If your GAHT involves taking testosterone, it might be important to know that long-term testosterone use can lower your risk of breast cancer. This isn’t the case for low-dose or intermittent testosterone use, however. 
2. Surgeries: If you’ve had a mastectomy, most if not all your breast tissue should have been removed, which often reduces your risk of breast cancer significantly. If you’ve had surgery to flatten the appearance of your chest, your risk of breast cancer is slightly, but not completely lowered. This is because you likely still have some breast tissue present in your body. While you may not have enough tissue to be tested for breast cancer with a mammogram, you can still be checked via breast exams. These exams can be done on your own or with the help of a health care provider. Surgeries like the introduction of breast implants or breast augmentation won’t impact your risk of breast cancer because the implants will be a synthetic material. Hysterectomies and oophorectomies may also somewhat reduce breast cancer risk—because the removal of such organs reduces of the amount of estrogen in the body, which is responsible for some forms of breast cancer—, though not as much as removal of breast tissue. 
3. Family history: For AFAB individuals or those who have been taking estrogen for five to ten years, it’s recommended that you get a mammogram every year starting at age 45. That said, your journey with GAHT and surgery may affect your body differently. Speak with a health care provider about any individual factors impacting your predisposition. For example, getting checked regularly is especially important if you have the BRCA1 or BRCA2 gene mutations or have a strong family history of breast cancer. If you feel uncomfortable with a mammogram, consider asking a health care provider about the possibility of using breast magnetic resonance imaging (MRI) or ultrasound to detect breast cancer. 

Nutrition needs 

When it comes to nutritional needs, recommendations for transgender individuals don’t differ greatly from those for cisgender individuals. However, GAHT often impacts weight and muscle mass, and therefore impacts metabolism, potentially resulting in weight change. If you choose to have gender-affirming surgery, your diet can be important in the healing process—increasing protein and calorie intake can promote recovery. Overall, because your nutritional needs might come down to your unique body make-up, speaking with a health care provider or dietician can be a great way to figure out what your body needs.  

Bone health

Certain forms of GAHT impact bone health. Levels of both testosterone and estrogen regulate bone development, especially during puberty. This means that GAHT can interfere with bone development and maintenance, especially if it lowers your levels of these hormones. Reduced bone mineral density (BMD), which can, in part, result from lowered estrogen or testosterone, makes you more at risk for fractures, osteopenia, and osteoporosis. Not properly following the use and dosage of your GAHT most often contributes to osteopenia and osteoporosis. Aside from this, your risk for osteoporosis depends on very individual factors about you, like your sex assigned at birth, your BMD before any GAHT, any surgeries you’ve had, and your specific GAHT regimen. Because your individual risk isn’t clear cut, it can be helpful to have a health care provider routinely test for osteoporosis. Additionally, there are things you can do to help prevent getting osteoporosis. For example, you might try developing muscle mass to help support your bones and incorporating calcium into your diet.  

How can you find support?

Given the lack of information known about health guidelines for transgender individuals, it’s helpful to consult with health care providers and build your support network. Finding support groups can be a great way to learn from others and have your frustrations or concerns met with empathy and understanding. Some transgender support groups are specific to certain conditions, like cancer, for example: 

• CoppaFeel! 
• National LGBT Cancer Network Peer Support Groups 
• FORCE (Facing Our Risk of Cancer Empowered) LGBTQIA+ Virtual Support Group 

There are a number of other groups you might find with an internet search of any health concerns or diagnosis you have. You might also find it helpful to work with providers who have a history of working with transgender patients. They may be more well-versed in finding creative techniques to support your health. In addition to creating a supportive care team, you might find it helpful to talk to peers and support groups about their experiences with providers and seek advice on how to navigate your health concerns.