LGBT Health
NHS Choices

Health Checks and Screening for LGBT people

There is evidence that LGBT people do not always have the health checks they need to stay healthy. This may be for a number of reasons. Assumptions are sometimes made about us, that we don’t need certain tests. For example, trans men may not be called for breast screening and/or cervical screening and trans women may not be called for breast screening or prostate screening.

If you are LGBT you may think that you are low risk because of your sexual orientation, gender identity, or because you have medically transitioned. However this is not always correct. Screening and self checking are important ways of protecting your health. It is a good idea to be informed about which screening and self-checks you need to receive.  

 

Screening

Screening is a way find out whether you are at risk of, or have, certain health conditions. Early treatment and information increases the options available. It also means that diseases are less likely to be passed on.

Screening is important for everyone. Finding out early that you are affected by a disease means that you have less risk of it affecting you in the long-term.

If you are LGBT, there are some screening tests that are especially relevant to you.

If you have changed your gender on NHS records, you may not be called for gender specific screening, such as cervical, breast and prostate. The exact screening you need will depend on the gender-reassignment treatment you have had, if any. Talk to your GP to ensure that you get screening reminders.

It is also important to self-check regularly. There is some evidence that transgender people may not always properly self-check their breasts, breast tissue or testicles. If you do not like these parts of your body, you may not want to touch them or be reminded of them. However it is still important that you check these parts of your body.

 

Cervical screening

If you have a cervix, you are at risk of cervical cancer. You should have a smear test every 3 years, or every 5 years if you are over 50. You should receive reminders from your GP surgery. You can request a smear test if you have not had a reminder. If you are registered as a man but you still have a cervix, you may need to request to have reminders sent to you.

Lesbians, and bisexual women in relationships with other women, occasionally report being told by healthcare professionals that they don’t need to have smear test. This is incorrect. If your healthcare professionals refuse to give you a smear test or you are not registered with a GP, you can also ask for one at the GUM clinic. You should consider changing practices and/or making a complaint if you have been refused a smear test.

For more information, see the Cervical Screening Wales website.

 

Breast cancer screening

If you have breast tissue, or have had breast tissue in the past, you are at risk of breast cancer. This includes trans men, non-binary people who were assigned female at birth (AFAB), as well as trans women and male-assigned-at-birth non-binary people who have taken oestrogen. If you have not undergone pregnancy and/or breastfed a baby you are at an especially high risk.

If you are a man you can still get breast cancer. Nearly 300 men per year in the UK are diagnosed with breast cancer, but unfortunately it is often diagnosed too late because they do not self-check. If you are a trans man taking testosterone you may be at greater risk even if you have had top surgery. For men, self-checking follows the same pattern as advised for women (see below).

According to Stonewall, around 8% of older lesbian and bisexual women will develop breast cancer, compared with around 5% of women overall. Breast cancer is much more likely to be treatable if caught early.

There are two ways to check for breast cancer: self-checking and screening.

 

Breast self-checking

Self checking should be done by everyone who has or has had breast tissue. If you notice any abnormalities it is important to discuss this with a healthcare professional as soon as possible.

If you have had breast tissue in the past you are still at risk. Cancer may spread more quickly in those who have had a mastectomy due to a previous lump, or top surgery for trans men, especially if you are taking testosterone. Some trans men find it very difficult to check breast tissue both before and after surgery. However, it is really important that you do it.

 

Breast screening

If you are between 50 to 70 and registered as female with your GP, you will be automatically invited for screening every three years. Older lesbians and bisexual women are at higher risk of breast cancer. This may be because they are less likely to have been pregnant or breastfed. If you are an older lesbian or bisexual woman, it is really important you attend screening. If you are worried or reluctant to go, you can take a partner or friend. If you do not get an invitation to screening, contact Breast Test Wales.

If you have had breast tissue in the past but have had top surgery, you are still at risk. You may still have a small amount of breast tissue left. Cancer may spread more quickly especially if you are taking testosterone. This makes it important that you receive screening, even if you are not registered as female with the surgery. You will need to speak to your GP or surgical team about how you can be screened in future.

For more information about breast screening, as well as how to spot any changes in your breasts, you can look at our section on breast cancer. This may be more relevant to you if you are a cis woman. If you are not, the Terrence Higgins Trust has a good resource. See the section on breast screening in the Trans Women Surgery ‘upper’ topic.

For more information visit the Breast Test Wales website.

 

Prostate cancer

If you have a prostate, you are at risk of prostate cancer. Symptoms of prostate cancer can be found here. Part of the test includes an examination of your prostate gland. This is usually done anally, but if you have had a vaginoplasty you may need to have the digital test done vaginally.

If you are not registered as male with the NHS, you may not be called for prostate screening. If you have a prostate, even if you have had lower surgery, you need screening for prostate cancer. Talk to your GP.

Prostate Cancer UK: understanding the prostate

Cancer Research UK: prostate cancer symptoms

 

Testicular cancer

If you have testicles, you are at risk of testicular cancer.

If you are female but have testicles, you might find it unpleasant to check them. However, it is really important that you do.

If you find anything unusual, any lumps, swellings or changes to your testicles, then you should speak to your GP.

Information on self-checking from Cancer Research UK.

A-Z topic for testicular lumps and swellings.

 

Sexual Health Checks

If you are sexually active it is important to look after your sexual health. This is especially important if you have multiple partners or regularly change partners,.

For more information see the pages for Sexual Health for LGBT women, non-binary people and trans men and women, Sexual Health for LGBT men, non-binary people and trans men and women, HIV and AIDS, and the A-Z topic STI pages.

You can get a free, confidential and anonymous sexual health check from a genitourinary medicine (GUM) clinic.

Find your nearest GUM clinic.

 

General Health checks for everyone

You are eligible for NHS bowel cancer screening from the age of 60, and for a blood pressure check every five years or so from the age of 40 (more often if your blood pressure is raised).

For more information see bowel cancer A-Z topic; blood pressure screening A-Z topic.

 

Resources

Trans health articles at Gires https://www.gires.org.uk/health

LGBT Cymru helpline and counselling service http://www.lgbtcymruhelpline.org.uk/news.html

 

Information on health concerns and discrimination

Research on LGBT health concerns is available at Stonewall Cymru

Unhealthy Attitudes is a report on discrimination in healthcare

Research on Trans mental health is available at Gires