Increased Surveillance or Increased Scrutiny: Curbing Inappropriate Screening of Endometrial Cancer in Transgender Men
,
Abstract
Objective: The transgender male body is often considered a “black box” by even the most senior of attending physicians. Because of the stigma and fear associated with the utilization of Hormone Replacement Therapy (HRT) and the lack of clinical knowledge surrounding the subject, many transgender men will experience unnecessary testing for endometrial cancers.
Materials and methods: This narrative review looked through publicly available PubMed and GoogleScholar articles on the topic of the use of pelvic ultrasounds in gynecological screening in transgendered males. 18,000 articles were filtered by relevance, date, clarity of the topic, and clinical recommendations. Of these articles 37 were included for discussion.
Results: Of these 18,000 articles, only 37 were included for discussion. The resulting table, diagnostic tree, and discussion section are included within.
Conclusion: Herein, the authors discuss the current understanding of the role of imaging in the diagnosis and treatment of gynecological cancers in transgendered men and how unnecessary imaging studies can be curbed for the benefit of the patient and the medical system at large.
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2. Unger CA. Hormone therapy for transgender patients. Transl Androl Urol. 2016 Dec;5(6):877-884.
3. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ 3rd, Spack NP, Tangpricha V, Montori VM; Endocrine Society. Endocrine treatment of transsexual persons: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009 Sep;94(9):3132-54.
4. University of California San Francisco’s Gender Affirming Health Program, Overview of masculinizing hormone therapy. https://transcare.ucsf.edu/guidelines/masculinizing-therapy, 2016 (Accessed 09 June 2022).
5. Olson J, Schrager SM, Clark LF, Dunlap SL, Belzer M. Subcutaneous Testosterone: An Effective Delivery Mechanism for Masculinizing Young Transgender Men. LGBT Health. 2014 Sep;1(3):165-7.
6. Carswell JM, Roberts SA. Induction and Maintenance of Amenorrhea in Transmasculine and Nonbinary Adolescents. Transgend Health. 2017 Nov 1;2(1):195-201.
7. Turner A, Chen TC, Barber TW, Malabanan AO, Holick MF, Tangpricha V. Testosterone increases bone mineral density in female-to-male transsexuals: a case series of 15 subjects. Clin Endocrinol (Oxf). 2004 Nov;61(5):560-6.
8. Defreyne J, Vantomme B, Van Caenegem E, Wierckx K, De Blok CJM, Klaver M, Nota NM, Van Dijk D, Wiepjes CM, Den Heijer M, T'Sjoen G. Prospective evaluation of hematocrit in gender-affirming hormone treatment: results from European Network for the Investigation of Gender Incongruence. Andrology. 2018 May;6(3):446-454.
9. Baba T, Endo T, Honnma H, Kitajima Y, Hayashi T, Ikeda H, Masumori N, Kamiya H, Moriwaka O, Saito T. Association between polycystic ovary syndrome and female-to-male transsexuality. Hum Reprod. 2007 Apr;22(4):1011-6.
10. Bosinski HA, Peter M, Bonatz G, Arndt R, Heidenreich M, Sippell WG, Wille R. A higher rate of hyperandrogenic disorders in female-to-male transsexuals. Psychoneuroendocrinology. 1997 Jul;22(5):361-80.
11. Loverro G, Resta L, Dellino M, Edoardo DN, Cascarano MA, Loverro M, Mastrolia SA. Uterine and ovarian changes during testosterone administration in young female-to-male transsexuals. Taiwan J Obstet Gynecol. 2016 Oct;55(5):686-691.
12. Grimstad FW, Fowler KG, New EP, Ferrando CA, Pollard RR, Chapman G, Gray M, Gomez Lobo V. Ovarian Histopathology in Transmasculine Persons on Testosterone: A Multicenter Case Series. J Sex Med. 2020 Sep;17(9):1807-1818.
13. Williams T, Mortada R, Porter S. Diagnosis and Treatment of Polycystic Ovary Syndrome. Am Fam Physician. 2016 Jul 15;94(2):106-13.
14. Ikeda K, Baba T, Noguchi H, Nagasawa K, Endo T, Kiya T, Saito T. Excessive androgen exposure in female-to-male transsexual persons of reproductive age induces hyperplasia of the ovarian cortex and stroma but not polycystic ovary morphology. Hum Reprod. 2013 Feb;28(2):453-61.
15. Yin W, Falconer H, Yin L, Xu L, Ye W. Association Between Polycystic Ovary Syndrome and Cancer Risk. JAMA Oncol. 2019 Jan 1;5(1):106-107.
16. Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2014 Sep-Oct;20(5):748-58.
17. Siu VJ, Varkey T, Khan UN, Ding JB, Gandhi S. Lend Me a Hand: A Value-Based Care Case Study on Pan Plexopathy of Unknown Origin. Cureus. 2021 Dec 12;13(12): e20354.
18. Trabert B, Wentzensen N, Felix AS, Yang HP, Sherman ME, Brinton LA. Metabolic syndrome and risk of endometrial cancer in the United States: a study in the SEER-medicare linked database. Cancer Epidemiol Biomarkers Prev. 2015 Jan;24(1):261-7.
19. National Cancer Institute, PDQ Endometrial Cancer Screening. https://www.cancer.gov/types/uterine/hp/endometrial-screening-pdq, 2022 (Accessed 09 June 2022).
20. Defreyne J, Vanwonterghem Y, Collet S, Iwamoto SJ, Wiepjes CM, Fisher AD, et al. Vaginal bleeding and spotting in transgender men after initiation of testosterone therapy: A prospective cohort study (ENIGI). Int
J Transgend Health. 2020 Feb 12;21(2):163-175.
21. Carswell JM, Roberts SA. Induction and Maintenance of Amenorrhea in Transmasculine and Nonbinary Adolescents. Transgend Health. 2017 Nov 1;2(1):195-201.
22. University of California San Francisco’s Gender Affirming Health Program, Pelvic pain and persistent menses in transgender men. https://transcare.ucsf.edu/guidelines/pain-transmen, 2016 (Accessed 09 June 2022)
23. University of California San Francisco’s Gender Affirming Health Program, Ovarian and endometrial cancer considerations in transgender men. https://transcare.ucsf.edu/guidelines/ovarian-cancer, 2016 (Accessed 09 June 2022)
24. Hawkins M, Deutsch MB, Obedin-Maliver J, Stark B, Grubman J, Jacoby A, Jacoby VL. Endometrial findings among transgender and gender nonbinary people using testosterone at the time of gender-affirming hysterectomy. Fertil Steril. 2021 May;115(5):1312-1317.
25. Puechl AM, Russell K, Gray BA. Care and Cancer Screening of the Transgender Population. J Womens Health (Larchmt). 2019 Jun;28(6):761-768.
26. Medicare Services, Procedure price lookup for outpatient services. https://www.medicare.gov/procedure-price-lookup/cost/76830/, 2022 (Accessed 09 June 2022)
27. James S, Herman J, Rankin S, Keisling M, Mottet L, Anafi MA. The report of the 2015 US transgender survey. National Center for Transgender Equality. Published online 2016. Accessed August 30, 2018. Available from: https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
28. Peitzmeier SM, Khullar K, Reisner SL, Potter J. Pap test use is lower among female-to-male patients than non-transgender women. Am J Prev Med. 2014 Dec;47(6):808-12.
29. University of California San Francisco’s Gender Affirming Health Program, Screening for cervical cancer in transgender men. https://transcare.ucsf.edu/guidelines/cervical-cancer, 2016. (Accessed 12 Febuary 2022)
30. Qureshi IA, Ullah H, Akram MH, Ashfaq S, Nayyar S. Transvaginal versus transabdominal sonography in the evaluation of pelvic pathology. J Coll Physicians Surg Pak. 2004 Jul;14(7):390-3.
31. Nahlawi S, Gari N. Sonography Transvaginal Assessment, Protocols, And Interpretation. In: StatPearls. Treasure Island: StatPearls Publishing; 2022.
32. Moorthy RS. Transvaginal sonography. Med J Armed Forces India. 2000 Jul;56(3):181-183.
33. McKinnish TR, Burgess C, Sloan CA. Trauma-informed care of sexual and gender minority patients. Cham: Springer International Publishing, 2022
34. Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008 Dec;20(12):600-7.
35. Lowes R. Patient-centered care for better patient adherence. Fam Pract Manag. 1998 Mar;5(3):46-7, 51-4, 57.
36. Clay AM, Parsh B. Patient- and Family-Centered Care: It's Not Just for Pediatrics Anymore. AMA J Ethics. 2016 Jan 1;18(1):40-4.
37. Centor RM. To be a great physician, you must understand the whole story. MedGenMed. 2007 Mar 26;9(1):59.
2. Unger CA. Hormone therapy for transgender patients. Transl Androl Urol. 2016 Dec;5(6):877-884.
3. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ 3rd, Spack NP, Tangpricha V, Montori VM; Endocrine Society. Endocrine treatment of transsexual persons: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009 Sep;94(9):3132-54.
4. University of California San Francisco’s Gender Affirming Health Program, Overview of masculinizing hormone therapy. https://transcare.ucsf.edu/guidelines/masculinizing-therapy, 2016 (Accessed 09 June 2022).
5. Olson J, Schrager SM, Clark LF, Dunlap SL, Belzer M. Subcutaneous Testosterone: An Effective Delivery Mechanism for Masculinizing Young Transgender Men. LGBT Health. 2014 Sep;1(3):165-7.
6. Carswell JM, Roberts SA. Induction and Maintenance of Amenorrhea in Transmasculine and Nonbinary Adolescents. Transgend Health. 2017 Nov 1;2(1):195-201.
7. Turner A, Chen TC, Barber TW, Malabanan AO, Holick MF, Tangpricha V. Testosterone increases bone mineral density in female-to-male transsexuals: a case series of 15 subjects. Clin Endocrinol (Oxf). 2004 Nov;61(5):560-6.
8. Defreyne J, Vantomme B, Van Caenegem E, Wierckx K, De Blok CJM, Klaver M, Nota NM, Van Dijk D, Wiepjes CM, Den Heijer M, T'Sjoen G. Prospective evaluation of hematocrit in gender-affirming hormone treatment: results from European Network for the Investigation of Gender Incongruence. Andrology. 2018 May;6(3):446-454.
9. Baba T, Endo T, Honnma H, Kitajima Y, Hayashi T, Ikeda H, Masumori N, Kamiya H, Moriwaka O, Saito T. Association between polycystic ovary syndrome and female-to-male transsexuality. Hum Reprod. 2007 Apr;22(4):1011-6.
10. Bosinski HA, Peter M, Bonatz G, Arndt R, Heidenreich M, Sippell WG, Wille R. A higher rate of hyperandrogenic disorders in female-to-male transsexuals. Psychoneuroendocrinology. 1997 Jul;22(5):361-80.
11. Loverro G, Resta L, Dellino M, Edoardo DN, Cascarano MA, Loverro M, Mastrolia SA. Uterine and ovarian changes during testosterone administration in young female-to-male transsexuals. Taiwan J Obstet Gynecol. 2016 Oct;55(5):686-691.
12. Grimstad FW, Fowler KG, New EP, Ferrando CA, Pollard RR, Chapman G, Gray M, Gomez Lobo V. Ovarian Histopathology in Transmasculine Persons on Testosterone: A Multicenter Case Series. J Sex Med. 2020 Sep;17(9):1807-1818.
13. Williams T, Mortada R, Porter S. Diagnosis and Treatment of Polycystic Ovary Syndrome. Am Fam Physician. 2016 Jul 15;94(2):106-13.
14. Ikeda K, Baba T, Noguchi H, Nagasawa K, Endo T, Kiya T, Saito T. Excessive androgen exposure in female-to-male transsexual persons of reproductive age induces hyperplasia of the ovarian cortex and stroma but not polycystic ovary morphology. Hum Reprod. 2013 Feb;28(2):453-61.
15. Yin W, Falconer H, Yin L, Xu L, Ye W. Association Between Polycystic Ovary Syndrome and Cancer Risk. JAMA Oncol. 2019 Jan 1;5(1):106-107.
16. Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2014 Sep-Oct;20(5):748-58.
17. Siu VJ, Varkey T, Khan UN, Ding JB, Gandhi S. Lend Me a Hand: A Value-Based Care Case Study on Pan Plexopathy of Unknown Origin. Cureus. 2021 Dec 12;13(12): e20354.
18. Trabert B, Wentzensen N, Felix AS, Yang HP, Sherman ME, Brinton LA. Metabolic syndrome and risk of endometrial cancer in the United States: a study in the SEER-medicare linked database. Cancer Epidemiol Biomarkers Prev. 2015 Jan;24(1):261-7.
19. National Cancer Institute, PDQ Endometrial Cancer Screening. https://www.cancer.gov/types/uterine/hp/endometrial-screening-pdq, 2022 (Accessed 09 June 2022).
20. Defreyne J, Vanwonterghem Y, Collet S, Iwamoto SJ, Wiepjes CM, Fisher AD, et al. Vaginal bleeding and spotting in transgender men after initiation of testosterone therapy: A prospective cohort study (ENIGI). Int
J Transgend Health. 2020 Feb 12;21(2):163-175.
21. Carswell JM, Roberts SA. Induction and Maintenance of Amenorrhea in Transmasculine and Nonbinary Adolescents. Transgend Health. 2017 Nov 1;2(1):195-201.
22. University of California San Francisco’s Gender Affirming Health Program, Pelvic pain and persistent menses in transgender men. https://transcare.ucsf.edu/guidelines/pain-transmen, 2016 (Accessed 09 June 2022)
23. University of California San Francisco’s Gender Affirming Health Program, Ovarian and endometrial cancer considerations in transgender men. https://transcare.ucsf.edu/guidelines/ovarian-cancer, 2016 (Accessed 09 June 2022)
24. Hawkins M, Deutsch MB, Obedin-Maliver J, Stark B, Grubman J, Jacoby A, Jacoby VL. Endometrial findings among transgender and gender nonbinary people using testosterone at the time of gender-affirming hysterectomy. Fertil Steril. 2021 May;115(5):1312-1317.
25. Puechl AM, Russell K, Gray BA. Care and Cancer Screening of the Transgender Population. J Womens Health (Larchmt). 2019 Jun;28(6):761-768.
26. Medicare Services, Procedure price lookup for outpatient services. https://www.medicare.gov/procedure-price-lookup/cost/76830/, 2022 (Accessed 09 June 2022)
27. James S, Herman J, Rankin S, Keisling M, Mottet L, Anafi MA. The report of the 2015 US transgender survey. National Center for Transgender Equality. Published online 2016. Accessed August 30, 2018. Available from: https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
28. Peitzmeier SM, Khullar K, Reisner SL, Potter J. Pap test use is lower among female-to-male patients than non-transgender women. Am J Prev Med. 2014 Dec;47(6):808-12.
29. University of California San Francisco’s Gender Affirming Health Program, Screening for cervical cancer in transgender men. https://transcare.ucsf.edu/guidelines/cervical-cancer, 2016. (Accessed 12 Febuary 2022)
30. Qureshi IA, Ullah H, Akram MH, Ashfaq S, Nayyar S. Transvaginal versus transabdominal sonography in the evaluation of pelvic pathology. J Coll Physicians Surg Pak. 2004 Jul;14(7):390-3.
31. Nahlawi S, Gari N. Sonography Transvaginal Assessment, Protocols, And Interpretation. In: StatPearls. Treasure Island: StatPearls Publishing; 2022.
32. Moorthy RS. Transvaginal sonography. Med J Armed Forces India. 2000 Jul;56(3):181-183.
33. McKinnish TR, Burgess C, Sloan CA. Trauma-informed care of sexual and gender minority patients. Cham: Springer International Publishing, 2022
34. Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008 Dec;20(12):600-7.
35. Lowes R. Patient-centered care for better patient adherence. Fam Pract Manag. 1998 Mar;5(3):46-7, 51-4, 57.
36. Clay AM, Parsh B. Patient- and Family-Centered Care: It's Not Just for Pediatrics Anymore. AMA J Ethics. 2016 Jan 1;18(1):40-4.
37. Centor RM. To be a great physician, you must understand the whole story. MedGenMed. 2007 Mar 26;9(1):59.
| Files | ||
| Issue | Vol 16, No 3 (September 2022) | |
| Section | Review Articles | |
| DOI | https://doi.org/10.18502/jfrh.v16i3.10576 | |
| Keywords | ||
| Evidence Based Imaging Transgendered Man Cancer Screening Transvaginal Ultrasound Pelvic Ultrasound Diagnostic Tree Value Based Care | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Adams E, Varkey T, Aijaz A, Taboada J, Ngyun A. Increased Surveillance or Increased Scrutiny: Curbing Inappropriate Screening of Endometrial Cancer in Transgender Men. J Family Reprod Health. 2022;16(3):170-175.
