Mammography Screening for Transgender Men
For transgender men (assigned female at birth) over 40 who have not undergone bilateral mastectomy, annual screening mammography is recommended following the same guidelines as cisgender women, regardless of testosterone therapy use. 1, 2
Key Screening Recommendations Based on Surgical History
For Transgender Men WITHOUT Bilateral Mastectomy
Annual screening mammography or digital breast tomosynthesis (DBT) should begin at age 40, identical to cisgender women, regardless of testosterone therapy duration or dose 1, 2
Testosterone therapy does NOT eliminate breast cancer risk and does not change screening recommendations for those with intact breast tissue 2, 3
The breast cancer risk remains similar to cisgender women when breast tissue is present, making standard screening protocols appropriate 1
For Transgender Men WITH Bilateral Mastectomy ("Top Surgery")
Imaging is usually not appropriate for breast cancer screening after complete bilateral mastectomy 1, 2
Annual chest wall examination may be warranted to assess for any residual breast tissue, though routine mammography is not indicated 2
High-Risk Transgender Men Require Enhanced Screening
For transgender men with elevated risk factors who have NOT undergone mastectomy, more intensive screening is warranted:
Start screening 8 years after chest radiation (but not before age 25) if radiation was received between ages 10-30 1
Start screening 10 years earlier than affected relative's age at diagnosis (but not before age 30) for those with familial breast cancer 1
High-risk factors include: personal history of breast cancer, chest irradiation, genetic predisposition (BRCA mutations), family history of breast or ovarian cancer, or untested first-degree relative with genetic predisposition 1, 2
Critical Implementation Considerations
The "organ inventory approach" is essential: screening decisions must be based on anatomical reality (presence or absence of breast tissue) rather than gender identity alone 2, 4
Common pitfall to avoid: Do not assume testosterone therapy reduces breast cancer risk sufficiently to defer screening in transgender men with intact breast tissue 3. The evidence shows breast cancer screening frequency should be individualized based on anatomy, patient age, and risk factors, but for average-risk patients over 40 with breast tissue, annual screening remains the standard 3.
Adherence challenges: Research demonstrates that mammography rates among transgender populations are significantly lower (2.0-50.0%) compared to cisgender patients (66.7-78.4%), highlighting the need for culturally sensitive care and clear communication about screening necessity 5.
Technical Considerations
DBT (3D mammography) and standard digital mammography are equivalent alternatives for screening transgender men with breast tissue 1
Staff training on accepted terminology and trauma-informed approaches is essential, as breast imaging may cause gender dysphoria 2
Documentation should reflect both natal anatomy and hormone-induced changes to ensure appropriate screening 2, 4