Clinical Considerations in the Context of Hormone Replacement Therapy
By: Dr. Angela Mazza
Introduction
Breast cancer is often thought of as a disease that only affects cisgender women, but the truth is: anyone with breast tissue can get breast cancer. That includes transgender women, transgender men, nonbinary people, and lesbian, gay, and bisexual individuals. This article is here to help you understand the facts, especially if you're part of the LGBTQ+ community or taking gender-affirming hormones.
How Hormones Affect Breast Cancer Risk
Hormone therapy is a powerful, gender-affirming treatment that supports many people in living as their true selves. It also changes how your body works, including how breast tissue develops. Here’s what the research shows:
• Transgender women (assigned male at birth, AMAB) who take estrogen grow breast tissue. Long-term estrogen use may raise the risk of breast cancer, especially after 5 to 10 years. Studies show their risk is higher than cisgender men but still lower than cisgender women [1].
• Transgender men (assigned female at birth, AFAB) who take testosterone may have less breast tissue, which can lower their risk. But if they haven't had top surgery (or if some breast tissue remains after surgery), there is still some risk [2].
• Nonbinary people may or may not use hormones, and their risk depends on whether they have breast tissue and what kind of hormones they take.
It’s important to know: hormones are not dangerous—they are life-saving for many people. But like all medical treatments, they should be monitored over time.
Other Risk Factors to Know
You may also be at higher risk if:
• You smoke or drink alcohol often
• You have a family history of breast cancer
• You are overweight or obese
• You haven’t been pregnant or breastfed
These are common factors in the general population, but some may be more common in LGBTQ+ communities due to stress, discrimination, or lack of access to affirming healthcare [3,4].
Regular screening can catch breast cancer early, when it's easier to treat. But many LGBTQ+ people avoid doctors due to past bad experiences, misgendering, or fear of discrimination. That’s why inclusive, respectful care is so important.
You may need screening if:
• You have breast tissue and are over age 40
• You’ve been on estrogen for over 5 years
• You have a family history of breast or ovarian cancer
Talk to a provider you trust about what screenings (like mammograms or ultrasounds) make sense for your body and your history.
How to Protect Your Health
• Find a provider who respects your gender identity and listens to your concerns.
• Share your hormone and surgical history so they can guide you on screening.
• Don’t wait to speak up if you notice changes in your chest or breasts, like lumps or nipple discharge.
• Advocate for yourself. You deserve care that sees and affirms you.
Conclusion
Breast cancer doesn’t care about gender identity or sexual orientation. What matters is that you know your risk, stay informed, and get care that respects who you are. Hormones are part of a healthy, affirming life for many—but understanding how they affect your body is an important step in caring for yourself. You deserve to feel safe, seen, and supported in every doctor’s office you walk into.
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