What screening tests are recommended for a 36-year-old female-to-male (FTM) individual on testosterone therapy for 5 years?

Screening Tests for a 36-Year-Old FTM Individual on Testosterone for 5 Years

This patient requires cervical cancer screening (if cervix retained), breast cancer screening (if chest surgery not performed), cardiovascular risk assessment with lipid panel, hematocrit/hemoglobin monitoring, liver function tests, and bone density assessment if risk factors present. 1

Testosterone Therapy Monitoring

Required Laboratory Tests

• Hematocrit and hemoglobin levels should be checked to detect polycythemia, a common side effect of long-term testosterone administration 2
• Testosterone levels should be monitored to ensure therapeutic dosing 1
• Lipid panel is essential as testosterone therapy can affect serum cholesterol 2
• Liver function tests should be obtained, as baseline values are needed and ongoing monitoring is recommended 1

Monitoring Frequency

• After 5 years of testosterone therapy, annual monitoring is typically appropriate for stable patients 1
• More frequent monitoring (every 3-6 months) may be needed if dose adjustments are made or complications arise 1

Cancer Screening Based on Organ Inventory

Cervical Cancer Screening (If Cervix Retained)

• Follow standard cisgender female screening guidelines regardless of testosterone use 1
• Screening should not be skipped based on gender identity or assumptions about sexual activity 1
• Age 36 typically requires screening per standard guidelines (Pap smear ± HPV testing based on current USPSTF recommendations) 1

Breast Cancer Screening (If No Chest Surgery)

• Transmasculine patients without chest surgery have breast cancer risk comparable to cisgender women regardless of testosterone therapy 1
• At age 36, routine mammography is not yet indicated unless additional risk factors are present (family history, genetic predisposition, prior chest radiation) 1
• Clinical breast examination and patient education about breast self-awareness remain appropriate 1

Ovarian/Uterine Considerations (If Organs Retained)

• No specific screening beyond standard cervical cancer screening is required 3
• Ovarian histopathology in transmasculine persons on testosterone has been shown to be benign in large cohort studies 3
• Pelvic examination should only be performed when clinically indicated, not routinely 1

Cardiovascular and Metabolic Screening

Lipid Monitoring

• Serum cholesterol may increase during androgen therapy and requires periodic monitoring 2
• This is particularly important given the patient's 5-year duration of therapy 2

Diabetes Screening

• Consider screening if additional risk factors present, as androgens may affect glucose metabolism 2
• In diabetic patients, testosterone may decrease blood glucose and alter insulin requirements 2

Bone Health Assessment

Bone Density Considerations

• Bone density preventive health education should not be skipped even though testosterone therapy is ongoing 1
• Baseline bone density assessment should be considered if risk factors are present (smoking, low body weight, family history, prior fractures) 1
• Testosterone therapy does not eliminate the need for bone health counseling, as individual responses vary 1

Sexually Transmitted Infection Screening

• STI screening questions are essential and should NEVER be skipped based on assumptions about sexual activity or risk 1
• Use inclusive, non-judgmental language when assessing sexual health 1
• Screen according to sexual practices and risk factors, not gender identity 1

Additional Screening Considerations

Thyroid Function

• While not specifically indicated by testosterone use alone, thyroid screening (TSH) may be appropriate if symptoms suggest thyroid dysfunction 4

Prostate Considerations

• Testosterone therapy in transmasculine individuals does not create prostate cancer risk equivalent to cisgender males 1
• Routine prostate screening is not indicated 1

Common Pitfalls to Avoid

• Do not assume sexual inactivity or low STI risk based on gender identity alone 1
• Do not skip cervical cancer screening if the cervix is retained, regardless of testosterone use or sexual orientation 1
• Do not overlook routine preventive care while focusing solely on hormone therapy monitoring 1
• Do not perform unnecessary invasive examinations that may cause trauma or worsen gender dysphoria 1
• Document an organ inventory to ensure appropriate screening is not missed 1