The following health concerns are relevant to many transgender and gender-expansive people (sometimes called gender non-binary or gender non-conforming). While these issues may not apply to everyone, they are important for everyone and their health providers to consider.

Barriers to Health Care

Some transgender people may not consult health care services because they have had negative experiences with doctors in the past. For that reason, organizations such as the World Professional Association for Transgender Health (WPATH) have created resources to help transgender people find knowledgeable, supportive, caring and compassionate providers in their communities.

For the best care possible, people should feel empowered to take an active role in their health by:

• Voicing concerns if something doesn’t seem right.
• Asking questions if they are unsure about any information.
• Being forthcoming about any medications and past surgeries, as these may affect treatment plans and preventive care options.

Transgender Violence

Transgender and gender-expansive people face a disproportionately high risk of physical and sexual violence in our society, much of which is motivated by hate or fear, and stems from a lack of understanding and acceptance. This violence can be perpetrated by loved ones, family and friends, or strangers, and can occur in the home, school, workplace or on the street.

Intimate Partner Violence

Intimate partner violence (sometimes called domestic violence) involves physical or emotional harm by a significant other — usually a partner, spouse or date. Typically, intimate partner violence begins with verbal threats and can escalate to physical abuse. Early recognition is important and individuals can seek help as soon as possible. Intimate partner violence often involves manipulation and control. Some of the barriers faced by gender-expansive survivors of intimate partner violence include:

• Access to support services.
• Lack of training on the part of service providers.
• Discrimination in shelters.

The National Coalition Against Domestic Violence has information on services and organizations that are inclusive and supportive of trans survivors. Research suggests that gender non-conforming people face intimate partner violence at much higher rates than other adults. However, victims 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 transgender and gender-expansive people, but specific assistance is available in certain areas.

Workplace Discrimination

Twenty-six percent of transgender and gender-expansive adults report being fired because of their identity. Because gender non-conforming people 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.

Sexual and Reproductive Health

Fertility Options

Some gender-expansive people aspire to have children or be parents. Because of this, all reproductive options and future plans, such as sperm banking, should be discussed with individuals before medical or surgical procedures that may reduce their future reproductive options.

Additionally, it’s important for gender-expansive people and their families to find a provider or center that understands their specific needs and offers services in a caring and compassionate environment. If you are interested in your fertility options, please consider discussing this during your intake interview with the Johns Hopkins Center for Transgender and Gender Expansive Health.

Preventive Care and Screenings

Sexual and reproductive health concerns for trans people may not be addressed due to the perception that people who have had gender affirmation surgery may not require clinical Pap tests, breast exams or prostate cancer screening.

These stereotypes and associated discrimination may make it uncomfortable for some gender-expansive people to access these important health care services. But while it may be unpleasant or even traumatic for some trans people to bring up these issues, early detection is essential for catching cancers while they are still treatable.

With that in mind, it is imperative that all individuals with a uterus, cervix, breasts or a prostate gland be offered regular preventive and diagnostic screenings for those organs.

Sexually Transmitted Infections (STIs)

Some transgender people are at greater risk for certain STIs. Aside from abstinence, the best method to prevent STIs is to use barriers, such as external condoms, internal condoms or dental dams, with every sexual encounter.

Fearing rejection or danger, trans people may not pressure their partners to use condoms — especially if sex work is involved or if the partner is violent. Barrier methods play an enormous role in STI prevention, so it is important for transgender and gender-expansive people to feel empowered to make safe sex decisions. There are a few sexually transmitted infections you should be aware of:

Human Immunodeficiency Virus (HIV)

HIV  is a virus that can lead to Acquired Immunodeficiency Syndrome (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 people 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 primary care clinician if PrEP is right for you.

Syphilis

Syphilis is a bacterial infection that causes small painless sores on your genitalia. It can harm the heart and nervous system if not treated in a timely manner. Syphilis is transmitted through oral, anal and vaginal sex.

Gonorrhea

Gonorrhea is a bacterial infection that causes painful urination and excessive discharge from the vagina or penis. It 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.

Chlamydia

Chlamydia is a bacterial infection that causes painful urination, excessive vaginal discharge, and sometimes testicular swelling. Often times there are no symptoms for the first few weeks. If left untreated, chlamydia can lead to pelvic inflammatory disease (PID), ectopic pregnancy, infertility, and long term pelvic pain. Chlamydia is passed between partners through oral, anal and vaginal sex. It is important to be tested and treated for chlamydia in a timely manner.

Hepatitis A and B

Hepatitis A and hepatitis B are 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 to prevent hepatitis A and B are available, and transgender people should discuss them with their health care provider to ensure initial vaccinations and booster shots are received.

Human Papillomavirus (HPV)

HPV is a group of viruses that can cause genital warts and certain cancers. HPV is spread through oral, anal and vaginal sex. A vaccine may be able to protect some people from the forms of HPV that can lead to certain cancers.

Other Infections

Meningitis is most often spread through germs in coughs and sneezes, but can also be passed to others through close contact. People with compromised immune systems — for example, those living with HIV or AIDS — are especially at risk. People should talk to their health care providers about immunization against meningitis.

Substance Use Disorder

Gender-expansive people are more likely than the general population to drink alcohol and smoke, and these behaviors are often linked to the high levels of discrimination and lack of acceptance faced by trans individuals in our society.

This is a very important health concern because the use of these substances is linked to substance use disorder, multiple forms of cancer and conditions of the heart and lungs. Among other dangerous health effects, tobacco use puts people at much higher risk for several cancers. It also contributes to wound healing complications if you decide to proceed with gender affirming surgery. Excessive alcohol use contributes to permanent liver damage and risky sexual behaviors. The use of illicit substances can increase risk for some of the infections listed above. Drug use or misuse use may also impair psychological stability and lead to further mental health problems.

Trans people who do not have reliable access to hormones from their doctor may try to get them elsewhere. In proper doses, hormones are safe, but they should be prescribed and monitored by a physician to guard against dangerous side effects.

Silicone Injections

The use of unmonitored silicone injections is also a health concern for trans people who may be unable to access professional cosmetic surgery. These illegal injections often contain toxic ingredients and can lead to severe disfigurement and even death.