Sorry for being MIA! I’ve been battling with my health for a while. I may finally have a new diagnosis for what’s been going on!

baku-bowl:

Do transmen need pap smears?

I had a patient this week who was a transgender man who was beginning the process of starting testosterone therapy, and I got to have a conversation with him about pap smears and cervical cancer screening, so I thought that as your friendly Tumblrhood doctor, I’d share some of that information, as well as general screening guidelines for all individuals who own a cervix.

1)Trans men who still have a cervix and have not undergone hysterectomy should continue to get pap smears. Cervical cancer is still possible due to HPV infection, and according to current research the guidelines for men with cervixes is the same as those for cisgender women with cervixes. This could always change in the future as more research is done, because that’s how science works, but for now these are the recommendations.

2) Transgender medical care is still not broadly taught at most medical schools and residency training locations, so be aware that not all providers will be versed in how to take care of you specifically. Hopefully they’re not douches and will respect you as their patient and do their proper research if they haven’t encountered care for LGBTQ+ individuals before, but… I’ve run into a lot of douches in my training, so please take care of yourselves. If you have transgender friends or know of LGBTQ organizations near you, reach out to them to see if they have recommendations for particular providers that are LGBTQ friendly.

3) Transgender men on testosterone tend to have a higher rate of unsatisfactory pap test results due to cervical changes and atrophy caused by testosterone, and are recommended to have repeat paps for a better sample. Don’t be discouraged - a lot of time this can be mitigated by the provider making a notation for the lab that the patient is on testosterone and whether or not they are amenhorreic (not having menstrual cycles). Hopefully your physician will know to do that, but considering point 2 above, it never hurts to pointedly ask them if they’ll tell the lab that.

4) Insurance bounce-back/non-coverage can sometimes be an issue if your documentation has you labeled as male. If this happens, simply ask your physician to help you appeal this by either reaching out to your insurance to clarify the issue, or having them write a letter addressing it for your appeal. It should be covered once that’s cleared up.

Now, for general pap screening guidelines (keep in mind, these are for the USA, and other countries may/will have different guidelines):

• Start at 21 years old (unless you have HIV, in which case speak with your doctor about when you should start, because it may likely need to be earlier).
• Ages 21 to 29, pap smears for routine screening are every 3 years if your results return normal.
• Ages 30 to 65, pap smears can be every 5 years if they return normal IF it is done as cytology with co-testing for HPV. If HPV is not tested, then it’s still every 3 years.
• If you have never had vaginal (penetrative or oral) intercourse, you may not need a pap. There is still a very low risk of cancer development based on things such as smoking, family history, etc., but overall the vast majority of cervical cancer is caused by HPV, which is sexually transmitted. If you’ve never been exposed to HPV through sex, your risk of developing cancer is very low.
• You still need pap smears even if you’ve had the HPV vaccine.
• If you’ve had a hysterectomy in which your cervix was also removed (which is the standard way of doing it these days, but wasn’t always in the past), and your hysterectomy was not due to cancer (and you’ve never had a significantly abnormal pap), you do not need to continue getting pap smears.

I could say more, but I’ll stop here. Overall, please discuss pap smears with your doctor if you currently have (or have had) a cervix to see if you need to have them and when.

Also, if you have had experiences with pap smears as a transgender individual, please add on with any advice you’ve found! I was never formally taught transgender care in my medical training and had to learn it through my own research, so I’m always curious to see how other providers who may be more experienced than me with it practice.

Hope this helps. ✌️