Gynecologist: Should I continue as a transgender man?

Dear Reader,

It’s totally understandable that you might be confused about your gynecological needs as a transgender man — after all, much of the gynecological messaging is geared towards cisgender women without consideration for individuals with similar health care needs who don’t fall into that gender identity. It’s a common misconception that trans men who are taking hormones or no longer have vaginal sex don’t need to visit the gynecologist, but that isn’t the case. In short, it’s wise for anyone with a uterus and ovaries, regardless of gender identity, hormone treatment, or sexual activity, to seek out gynecological care, unless these organs are removed through gender affirmation surgery (previously referred to as gender reassignment surgery or GRS).

While visiting the gynecologist can be nerve-racking for anybody, it can be especially intimidating for trans men and transmasc folks. A common concern for trans men and transmasc patients is that visiting the gynecologist will trigger or exacerbate gender dysphoria (the incongruity between gender identity and sex assigned at birth), particularly during a routine examination. Another concern is that they might encounter a physician who is insensitive, ignorant, or uneducated about trans issues and transmasc needs, which can cause patients to feel extremely uncomfortable, unsafe, and discriminated against.

While these concerns might deter you from seeking care, visiting with a trained provider can help reduce those feelings of being overwhelmed. Enforcing policies and processes such as using the correct pronouns for every patient, providing gender-inclusive bathrooms and avoiding gender-specific decor and signage, displaying a nondiscrimination policy in clear view, providing educational materials on trans health, and avoiding making assumptions about patients’ sexual orientation and activity are strategies for making patients feel more comfortable. By taking these steps, providers can work towards building a trusting, open, and safe relationship with their trans men and transmasc patients, which in turn can help make the gynecological process easier. 

The good news is that there are a number of resources for finding a trans-friendly provider. A great place to start is by visiting the GLMA: Health Professionals Advancing LGBTQ Equality website and searching the Provider Directory to find a provider that’s right for you.

Once you’ve found a provider you feel safe and comfortable with, there are a few different concerns to discuss with them. These include:

• Pelvic exam with a Pap smear: While taking testosterone can and usually does stop menstruation, it doesn’t stop the need for regular pelvic exams. Some health care providers have found a higher rate of polycystic ovary syndrome (PCOS) in their patients who are taking testosterone. Untreated PCOS is associated with an increased risk of endometrial cancer. If you’re not comfortable with a standard Pap smear, you can ask your provider if you can try a different position or an alternate method during the exam.
• Breast exam: Although having a bilateral mastectomy puts transgender men at a lower risk of developing breast cancer, it’s still key to get breast tissue checked. This is especially critical if you bind your breasts.
• Hormone use: It's good to make sure that you’re using the right levels of testosterone. Too high of a level of testosterone comes with the risk of liver damage. You may also want to discuss any side effects from hormonal therapy, such as vaginal dryness and issues with your bladder and urinary tract with your health care provider.
• Menstrual bleeding: Hormone use usually causes menstrual bleeding to completely stop within five months. It’s best to get any bleeding that you experience after your periods stop further examined as it could signal a serious health concern.

Ultimately, the most critical thing is that you receive the care you need provided by a professional you trust!

Good luck!