Trans Women's Health Issues
Research has shown that the following are some of the most common health concerns faced by trans women and male-to-female transgender individuals (MTF). While these concerns may not all apply to everyone, they are all important concerns for trans women and their health care providers to be aware of.
Access to Quality, Compassionate Health and Transition Care
Some transgender individuals may not access health care services because they had negative experiences with doctors in the past. For that reason, organizations like GLMA: Health Professionals Advancing LGBT Equality have created resources to help transgender individuals find knowledgeable, supportive, caring and compassionate providers in their community.
To receive the best care possible, trans women should feel empowered to take an active role in their health by:
Voicing concerns if something doesn’t seem right.
Asking questions if you’re unsure.
Being forthcoming about any medications and past surgeries, as these may affect treatment plans and preventive care options.
Transgender individuals face an exorbitant amount of physical and sexual violence in our society, much of which is motivated by hate and stems from a lack of understanding and acceptance. This violence can be perpetrated by loved ones, family and friends, and/or strangers, and can take place in a number of environments, including the home, school, workplace or on the street.
Intimate Partner Violence
Intimate partner violence takes many forms but involves physical or emotional harm by a significant other — usually a boyfriend, girlfriend, ex-boyfriend, ex-girlfriend or date. Typically, intimate partner violence begins with verbal threats and escalates to physical abuse, which is why it’s important to recognize it early and get help as soon as possible. Intimate partner violence often involves manipulation and control.
Research suggests that trans women face intimate partner violence at much higher rates than other adults, but these women may be hesitant to seek help because they fear discrimination from law enforcement and health care providers.
Sadly, not all intimate partner violence resources accommodate trans women, but specific assistance is available in certain areas.
Other Forms of Violence
Twenty-six percent of transgender adults report being fired because of their identity. Because trans women face such extreme job discrimination, some may turn to sex work as a last resort. This puts them at far greater risk of physical and sexual violence. Make sure you know your rights as an employee.
Sexually Transmitted Infections
Trans women are at greater risk for certain sexually transmitted infections (STIs). Aside from abstinence, the best method to prevent STIs is to use a condom every time you have sex.
Fearing rejection or danger, trans women may not pressure their male partners to use condoms — especially if sex work is involved or if the partner is violent. Condoms play an enormous role in STI prevention, so it’s important for trans women to feel empowered to make safe sex decisions.
HIV is a virus that can lead to AIDS if left untreated. HIV impairs the immune system’s ability to fight infections and certain cancers. HIV is spread through direct contact with body fluids that contain the virus — often through needle sharing and anal, vaginal and (very rarely) oral sex. Knowing your HIV status is an important part of protecting yourself and others.
Trans women at risk of HIV infection can talk with their health care provider about taking pre-exposure prophylaxis (PrEP) to prevent HIV. PrEP is a drug that, when combined with consistent condom use, can minimize HIV transmission. Ask your doctor if PrEP is right for you.
Syphilis is a bacterial infection that can harm the heart and nervous system if not treated promptly. Syphilis is transmitted through oral, anal and vaginal sex.
Gonorrhea is a bacterial infection that can lead to fertility complications if left untreated. Gonorrhea is passed between partners through oral, anal and vaginal sex. New, more drug-resistant strains are becoming increasingly common. It is important to be tested to ensure adequate treatment.
Hepatitis A and B
Hepatitis A and B are both viral infections that cause damage to the liver. Hepatitis A is mostly spread through contaminated food but can also be spread through anal and oral sex. Hepatitis B is transmitted through needle sharing and anal, oral and vaginal sex. Hepatitis A infections usually clear on their own, but hepatitis B can cause permanent or chronic damage to the liver, resulting in liver cancer.
Vaccines are available to prevent both hepatitis A and B and should be discussed with your health care provider if you haven’t already received them — or if you need a booster.
HPV is a group of viruses that can cause genital warts and certain cancers. HPV is spread through oral, anal and vaginal sex. Trans women can receive a vaccine to protect themselves against the forms of HPV that lead to genital warts and the development of certain cancers.
Meningitis is most often spread through germs in coughs and sneezes but can also be passed to others through close contact. Trans women with compromised immune systems — for example, those with HIV or AIDS — are especially at risk. Speak with your health care provider to see if you should receive an immunization against meningitis.
The Center for Transgender Health Team at Johns Hopkins
Embracing diversity and inclusion, the Center for Transgender Health provides affirming, objective, person-centered care to improve health and enhance wellness; educates interdisciplinary health care professionals to provide culturally competent, evidence-based care; informs the public on transgender health issues; and advances medical knowledge by conducting biomedical research.
Transgender Health | Johns Hopkins Center for Transgender Health
Trans women, especially those who take or have taken estrogen therapy, should receive regular screenings for breast cancer, including mammograms.
Reproductive health may go ignored because many assume women do not need prostate cancer screening. This assumption can make it uncomfortable — or even traumatic — for trans women to broach the topic, but early detection is key to catching the disease while it’s highly curable.
Those who have had a vaginoplasty still have a prostate.
Trans women should speak to their doctor about receiving Pap tests to screen for cancer.
Reproduction and Fertility
Some trans individuals aspire to have children or be parents. Because of this, all reproductive options and future plans, like sperm banking, should be discussed with individuals prior to obtaining trans-specific medical care and surgical procedures that may reduce their future reproductive options. Additionally, it’s important for trans women and their families to find a provider or center that understands their specific needs and offers services in a caring and compassionate environment.
Due to stress and discrimination, trans women are more likely to abuse tobacco and alcohol than the general population. Among other dangerous health effects, tobacco use puts women at much higher risk for several cancers, and excessive alcohol use contributes to permanent liver damage and risky sexual behaviors.
Additionally, trans women who do not have reliable access to female hormones from their doctor may try to get them elsewhere. In proper doses, estrogen is safe, but it should be prescribed and monitored by a physician to check for dangerous side effects, like blood clots.
The use of unmonitored silicone injections is also a health concern for trans women, who may be unable to access professional cosmetic surgery. These illegal injections often contain toxic ingredients and can lead to severe disfigurement and death.