Transgender and non-binary people and cancer

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 with cancer treatment helpful. It includes information about:

• talking to your healthcare team
• coping with negative healthcare experiences
• cancer, sex and fertility
• finding support.

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.

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.

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 UK Cancer and Transition Service (UCATS). They should ask permission to share your information before they do so. You can also refer yourself to this service.

The most important thing is to get the right support for you. You may find the suggestions below helpful.

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.

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.

We 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 our 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.

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 our 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.

Radiotherapy to the pelvic area (the area between the hips) can cause changes that may affect sexual well-being. We have 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:

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.

This page was developed in partnership with OUTpatients (formerly called Live Through This). OUTpatients is a cancer support and advocacy charity for the LGBTIQ+ community. They provide a safe space for anybody who identifies as part of the queer spectrum and has had an experience with any type of cancer at any stage, from testing, diagnosis, treatment, remission to long-term care.

LGBTQ+ is an acronym for lesbian, gay, bi, trans and queer people, plus (+) any other romantic or sexual attraction other than heterosexual, and any gender identity other than cis.

Macmillan is working to improve how our cancer information works for LGBTQ+ people. There are areas of our information that we are still working on to make more inclusive.

When we write or update our information, we think about the needs of all different audiences. This includes people of all sexual orientations and gender identities. We are careful about the language and wording we use. We include information about specific LGBTQ+ issues when needed. We offer other useful sources of information and support when this is helpful.

We welcome feedback on any of our information. If you have feedback, please contact us at cancerinformationteam@macmillan.org.uk