Trans people face a lot of discrimination, be it in society at large or even in the health care system. Because of this, a lot of trans and queer people avoid or even fear going to seek help from medical professionals. As a queer and non-binary person of color, I dread the feeling of going to the hospital; not only will it rake up a high cost, but it may also involve subtle or blatant queerphobia.
If you are a trans man, you transition from female to male, then you need gynecological care, especially if you haven’t had gender reaffirming surgery. This is important to avoid any complications during your transition process, and transitioning is not a monolith; it looks different for one trans person to the next. So, without further ado, let’s dive into this blog and learn everything you need to know about gynecological care for trans men.
Find a doctor with whom you feel comfortable talking about your concern and medical history. I know going to the doctor as a queer person can be scary, but don’t let the stigma scar you and prevent you from getting the care that you need. Once you have established a relationship with your doctor and are comfortable with them, you can share your past and current gender-related use of hormones and surgical interventions.
You need to know your body in order for your doctor to help you, and you might even have to provide a sexual, gynecologic, psychiatric, and obstetric history and even medical history to them so that they have a better grasp of your overall health.
Both men and women have breast tissue. Even if you have undergone superior surgery for transgender men that removes your breasts and creates a more masculine-shaped chest (breast masculinization surgery), you will still have residual breast tissue. Although the risk is greatly reduced, breast cancer can still occur. To promote breast tissue health:
- Tell your doctor if any family members of yours have had breast cancer.
- Find out from your doctor about early detection of breast cancer, such as an annual breast exam or regular mammograms.
- Be familiar with the feel of your chest wall or breast, its shape, and how it looks if you have had upper body surgery, and know what changes to look for that might indicate a problem. Tell your doctor or medical practitioner if you notice any changes.
Transgender men whose breasts have not been removed must undergo breast cancer screening according to guidelines for women whose gender identity and expression conform to stereotypical societal characteristics associated with the sex assigned at birth (cisgender). Screening recommendations vary. Ask your doctor what is best for you. If you have had your breasts removed and a mammogram is not physically possible, you may undergo an MRI or ultrasound to check your breast tissue.
Fertility and fertility preservation
Some trans men want to have children. Others do not. The decision is yours. But planning is important, and if you have a uterus and ovaries and have not been sterilized, you can still get pregnant by having vaginal sex with men of the same sex. This is also the case if you take testosterone or have irregular periods or no periods at all. Although testosterone can reduce the likelihood of pregnancy, you should not rely on testosterone therapy as a method of birth control. Pregnancy is still possible until menopause.
To avoid pregnancy, use a method of birth control such as condoms. If you are taking male hormones, you should avoid contraceptives containing the female hormone estrogen, including combination pills and birth control patches. If you are not using male hormones, an intrauterine device containing the hormone progesterone (Mirena) can be used as a contraceptive and reduce menstrual bleeding. You can also talk to your doctor about a permanent method of birth control.
If you want to get pregnant, talk to your doctor. If you are taking testosterone, you must stop it. Talk to your doctor or medical practitioner about how your hormone use may have impacted your fertility. There are methods of carrying a pregnancy to term or collecting and freezing unfertilized eggs or ovarian tissue for later use. These methods can be medicated or surgical and are usually offered at specialized fertility centers. However, these procedures are often costly. Whenever possible, it is best to make decisions about children before starting hormone therapy or undergoing genital surgery.
If you still have these organs, you may be at risk for cervical, ovarian, and uterine cancer. This is a reality whether or not you are on testosterone. Treatment with testosterone does not change your risk of developing these cancers. Your pelvic health is essential even if you do not have receptive or penetrative sex. To promote your pelvic health, your doctor may recommend the following:
- Testing for sexually transmitted infections (STIs)- You can become infected with an STI during oral, anal, or vaginal intercourse. STIs include chlamydia, gonorrhea, syphilis, herpes, and hepatitis. Human papillomavirus (HPV) and human immunodeficiency virus (HIV) can also be transmitted during sexual intercourse. Your doctor may ask you to get tested regularly for HIV and other sexually transmitted diseases. All you need to do for some screenings is give a blood or urine sample.
- Pap test- Your doctor will use a small, soft brush to take cells from your cervix. These cells are examined under a microscope for signs of cancer.
- A pelvic exam- During this exam, the uterus, vagina, ovaries, and cervix are checked for problems. During the pelvic exam, your doctor will examine your genitals and feel inside your vagina. A hinged, plastic, or metal duckbill-shaped instrument (speculum) is inserted into your vagina to help your doctor see your vagina and cervix.
Talk to your doctor about how to protect yourself from STIs, such as using condoms or other protection and avoiding unprotected sex unless you are sure you and your partner are not infected. Pre-exposure prophylaxis (PrEP) can also help prevent HIV infection in people who are not HIV-positive and are at very high risk.
Avoiding alcohol or drug use during sex can also help reduce the risk of STIs. Vaccinations can protect you from liver infections hepatitis A and hepatitis B. The HPV virus can cause cervical cancer and can also be transmitted to you during sexual intercourse. The HPV vaccine is available for children, adolescents, and young adults.
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