Pharmaceutical Considerations for Oncology Risk, Screening, and Drug Dosing in the Transgender Population

Transgender individuals make up a significant portion of the United States population, yet little data are available regarding oncologic considerations for this population. Transgender individuals may utilize gender-affirming hormone therapy to develop the desired secondary sex characteristics. Although there are few studies assessing hormone therapy and cancer risk in transgender individuals, available studies show no increased risk of cervical, ovarian, testicular, and prostate cancer associated with gender-affirming hormone therapy. Caution is advised when using estrogen therapy in transgender women who may be at higher risk for breast cancer due to family history or other considerations. Transgender patients should also be counseled on cancer screening recommendations depending on which tissues they have retained, even if those tissues are incongruous with their gender identity. Additionally, when providing oncologic care for transgender individuals, health care providers often utilize calculations for dosing and renal function that contain gender modifiers. Duration of hormone therapy can be utilized as a factor for determining whether to utilize gender assigned at birth or gender identity for these calculations. Through education and cultural awareness, health care providers can provide a simultaneously effective and gender-affirming medical experience to the transgender population.