Gynecological care for trans men

By Mayo Clinic Staff

If you're a trans man (female to male), you might need gynecological care. This is especially true if you haven't had genital surgery.

To determine your health care needs, find a doctor who understands your health issues and with whom you feel comfortable sharing your history and concerns. Don't let fear or the stigma you might face as a transgender person prevent you from getting the health care you need.

Once you've established a relationship with your doctor, share the history of your past and current gender-related use of hormones and surgical interventions. Knowing your current anatomy is important for your doctor to offer appropriate screening and treatment. You'll also need to provide a psychiatric, sexual, gynecologic and obstetric history and a family medical history. Ask about screenings and tests recommended for trans men in your age group. Your doctor will also consider your specific health concerns.

Breast tissue health

Men and women have breast tissue. Even if you've had top surgery for transgender men to remove your breasts and create a more male-contoured chest (masculinizing chest surgery), you'll still have some residual breast tissue. While the risk is greatly reduced, breast cancer can occur. To promote breast tissue health:

  • Tell your doctor if any family members have had breast cancer.
  • Become familiar with the look and feel of your breasts or your chest wall if you have had top surgery and know what changes to look for that might be a sign of a problem. Tell your doctor if you notice any changes.
  • Ask your doctor about breast cancer screening, including a yearly breast exam or regular mammograms.

Trans men who haven't had their breasts removed require breast cancer screenings based on guidelines for women whose gender identity and expression matches the stereotypical societal characteristics related to sex assigned at birth (cisgender). Screening recommendations vary. Talk to your doctor about what's right for you.

If you've had your breasts removed and a mammogram isn't physically possible, you might have an MRI or ultrasound to check your breast tissue.

Pelvic health

You might be at risk for cancer of the cervix, ovaries and uterus, if you still have these organs. This is true whether or not you take testosterone. Testosterone therapy doesn't change your risk of these cancers.

Your pelvic health is important, even if you don't have receptive or penetrative sex. To promote your pelvic health, your doctor might recommend:

  • A pelvic exam. This exam checks for problems with the uterus, vagina, ovaries and cervix. During a pelvic exam, your doctor looks at your genitals and feels inside your vagina. A plastic or metal-hinged instrument shaped like a duck's bill (speculum) will be placed in your vagina to help your doctor see your vagina and cervix.
  • Pap test. Your doctor will use a small, soft brush to collect cells from your cervix. These cells will be studied under a microscope for signs of cancer.
  • Sexually transmitted infection (STI) tests. You can get an STI from oral, anal or vaginal sex. STIs include chlamydia, gonorrhea, syphilis, herpes and hepatitis. The human papilloma virus (HPV) and the human immunodeficiency virus (HIV) also can be passed during sex. Your doctor might ask you to have regular screenings for HIV and other STIs. For some screenings, you only need to give a blood or urine sample.

Talk to your doctor about ways to protect yourself from an STI, such as by using condoms or other barrier protection and avoiding unprotected sex unless you're sure you and your partner aren't infected. Pre-exposure prophylaxis (PrEP) also can help prevent HIV infection in people who don't have HIV and are at very high risk of becoming infected. Avoiding use of alcohol or drugs during sex also may help decrease your risk of STIs.

Vaccines can protect you from the liver infections hepatitis A and hepatitis B. HPV, which can cause cancer of the cervix, also can be passed to you during sex. The HPV vaccine is available to children, teens and young adults.

Fertility and Fertility Preservation

Some trans men choose to have children. Others don't. The choice is up to you. But planning is important.

If you have a uterus and ovaries and haven't had a sterilization procedure, you can still get pregnant if you have vaginal sex with cisgender men. This is true even if you take testosterone or have irregular or no periods. Although testosterone might lessen your chance of pregnancy, don't rely on testosterone therapy for contraception. Pregnancy remains possible until menopause.

To prevent pregnancy, use a barrier form of birth control, such as condoms. If you aren't using masculinizing hormones, an intrauterine device that contains the hormone progestin (Mirena) can serve as birth control and decrease menstrual bleeding. You also might talk to your doctor about permanent birth control. If you are using masculinizing hormones, you might want to avoid birth control that contains the female hormone estrogen, including combination birth control pills and the birth control patch.

If you want to become pregnant, talk to your doctor. If you take testosterone, you'll need to stop. Talk to your doctor about how your hormone use may have affected your fertility. Procedures are available that make it possible to carry a pregnancy or to collect and freeze unfertilized eggs or ovarian tissue for future use. Methods might involve medication or surgical procedures and are typically available at specialized fertility centers. However, these procedures are often expensive. If possible, make decisions about children before you start hormone therapy or have genital surgery.

Testosterone use

Testosterone use can significantly increase your sex drive. Sexual arousal can come unexpectedly and more frequently. The hormone can also make your clitoris larger and your vaginal walls thin. If you have receptive sex, you might bleed or have pain. To address vaginal problems, use a water-based lubricant during sexual activity. If discomfort continues, your doctor might prescribe a topical cream that's applied inside the vagina.

Body image

A positive body image is important to your self-esteem and sexual health. Many trans men struggle with their body image, especially during times of major physical and emotional changes. Trans men may also feel pressure to look a certain way. This can be due to your cultural or family background or stereotypes promoted in the media.

Body shapes vary. There's no one "right" way to look. Talking about your body image might help you feel better. Consider what you like about the way you look. You might also use gender-affirming devices, such as a chest-binder, genital packer or stand-to-pee device.

If you struggle with body image concerns, talk to your doctor. Seeking counseling or attending a support group might help. If you haven't already, you might consider masculinizing hormone therapy or masculinizing surgery. Ask your doctor about the potential benefits and risks of these options.

Talk to your doctor about your sexual and gynecologic health. Ask questions and share any concerns you might have. Together, you can create a care plan that best meets your needs.

Nov. 13, 2019 See more In-depth