Recommended Screening for Transgender Man on Testosterone
This transgender man should undergo cervical cancer screening with HPV testing now, and repeat A1c and lipid panel should also be performed. 1, 2
Cervical Cancer Screening Priority
All persons with a cervix require cervical cancer screening regardless of gender identity or testosterone use. 1 The key considerations are:
- The last Pap smear was 6 years ago, which exceeds recommended screening intervals of 3 years for cytology alone or 5 years for HPV testing with cytology 1
- Despite HPV vaccination, screening remains necessary as vaccines do not cover all oncogenic HPV types 1
- Transgender men on testosterone have high rates of cervical cytology interpretation errors due to testosterone-induced atrophic changes, transitional cell metaplasia, and small cell findings that can mimic abnormalities 3, 4
- The clinical history of testosterone therapy must be provided to the cytopathologist to avoid overcalling abnormalities 3
Recommended approach: Perform HPV testing with cytology (co-testing) now, ensuring the laboratory is informed of the patient's transgender status and testosterone use 1, 3
Metabolic Monitoring for Testosterone Therapy
Testosterone replacement requires regular monitoring of metabolic parameters. 1, 5 The evidence supports:
- A1c should be repeated as it has been 1 year since last testing, and annual monitoring is recommended for adults with risk factors 2
- Lipid panel should be repeated as testosterone therapy affects lipid metabolism, particularly lowering HDL cholesterol toward male reference ranges 5
- Testosterone-treated transgender men show significant shifts in HDL values compared to cisgender women, requiring ongoing cardiovascular risk assessment 5
- Baseline monitoring at 1-2 months after initiation, then every 3-6 months for the first year, then yearly is the standard protocol 1
Additional Monitoring Considerations
While not explicitly asked about, testosterone monitoring should include 1:
- Hematocrit/hemoglobin (polycythemia risk)
- Blood pressure assessment
- Liver function if clinically indicated
- Digital rectal examination is not applicable for transgender men without prostates
What Is NOT Needed
Mammography is not indicated for this patient 1:
- Mammography screening begins at age 40-45 years for average-risk individuals 1
- No age is provided in this case, but the 5-year transition timeline suggests likely younger than screening age
- Testosterone therapy and chest masculinization surgery (if performed) further reduce breast tissue and cancer risk
Psychology referral is not a routine screening recommendation 1:
- Mental health support may be beneficial but is not part of standard preventive screening protocols
- No indication of psychological distress is mentioned in the case