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Health LGBTQ+

How about we try to stop people from dying?

Yesterday, there were thousands of posts on Twitter by anti-trans activists claiming that only women get cervical cancer.

It was a deliberate attack on trans men and non-binary people; the hashtag began after a trans man posted on Twitter about his cervical cancer diagnosis and a bunch of awful people started abusing him.

Think about that for a moment. Somebody has received possibly the worst news of their life, and thousands of people pile on to say in effect, “fuck you! You’re not a man! Only women get cervical cancer!”

Trans men and non-binary people are not women. However, if they have not had surgical intervention, their bodies will do the same thing women’s bodies do. And that means they are at risk of, and can die from, the same cancers as women.

Part of the pile-on was also aimed at trans women. It’s pretty twisted to wear susceptibility to cancer as a badge of honour – “haha! You can’t die in the same way we can!” – and it’s only partially true. Trans women don’t get cervical cancer if they haven’t had gender reassignment surgery. But if they have, they can develop similar carcinomas. Trans women who have undergone hormonal transition should also be screened for breast cancer.

The inclusive language that transphobes hate so much – people who menstruate, people with cervixes, people who can get pregnant and so on – does not exclude cisgender women. But it does include trans men and non-binary people, and that’s important. One of the reasons it’s important is because many trans people are not included in essential screening. Here’s Public Health England.

If you are a trans man aged 25 to 64 who has registered with a GP as male, you won’t be invited for cervical screening.

This is why organisations specifically try to include trans men in screening awareness programmes. If they don’t ask to be screened, they won’t be invited for screening.

There’s no reason why the system can’t record lived/legal gender and whether someone’s trans as separate categories; there are significant biological differences between trans men and cisgender men, and between trans women and cisgender women. Long-term hormone treatment also means there are significant differences between trans women and cisgender men, and between transgender men and cisgender women.

That complexity is currently reduced to a single item: M/F?

I’ve had some experience of this too. Long before I officially transitioned, my GP’s surgery said they wanted to change my gender marker on the NHS computer to female. The practice manager explained that if the marker wasn’t changed, the labs would continue to reject my blood samples because they had female-typical estrogen levels. As far as the labs were concerned, high estrogen proved that my samples had been mixed up with somebody else’s.

For me, changing my gender marker meant I started getting reminders to come for cervical cancer screening (you can contact your GP to opt out of those communications) and I won’t get reminders about prostate cancer screening when I’m older, so I need to be aware of that (although the hormones I take massively reduce my risk). For trans men, it means the reverse – and that’s a potential problem, because some trans men have an elevated risk of the very cancers they won’t be invited to screen for.

The general bullshit that LGBT+ people experience often means higher levels of potentially risky behaviour – smoking, drinking to excess and so on. But the biggest risk is that the terrible experiences trans people often endure when they try to access healthcare can prevent them from taking part in preventive screening, or from seeking help until the very last moment. With cancer, early detection is everything.

Here’s the US National LGBT Cancer Network.

For trans men, ovarian cancer poses an extra challenge, due not only increased risk factors and decreased access to healthcare but also to the increased levels of discrimination faced by the trans community.

One of the most famous examples of that is discrimination is Robert Eads, a trans man who was advised not to have gender reassignment surgeries because he was too old. He later died of ovarian cancer after twelve different doctors refused to treat him – not because he was a medical challenge, but because they didn’t want word getting out that they’d treated a trans man.

What those doctors did is what the Twitter mob did yesterday: they decided that their personal feelings about trans people were more important than saving someone’s life.