Doctors often aren’t trained on the preventive health care needs of gender-diverse people – as a result, many patients don’t get the care they need

Preventive health care – such as cancer screening – is a critical tool in the early detection of disease. Missed screening can result in a missed diagnosis, delayed treatment and reduced chances of survival.

But the medical system is poorly equipped to meet the needs of gender-diverse patients.

Around 1.64 million people in the U.S. identify as transgender, nonbinary or gender diverse – people whose gender identity differs from the sex they were assigned at birth.

This adds up to 1.3 million or 0.5% of U.S. adults, all of whom are more likely to encounter implicit, or unconscious, biases when they seek medical care compared with their cisgender counterparts – those whose gender identity aligns with the sex they were assigned at birth.

I am a primary care doctor in Appalachia, as well as a medical educator who studies how to improve the instruction of future health care providers. I work hard every day to improve the health of the underserved.

Primary care doctors devote much of their lives to preventive medicine – the art of stopping disease before it starts. Cancer screening consumes much of my life.

So I’m concerned about the barriers to preventive care for patients who are transgender, including consistent access to adequate cancer screening.

The problems with the binary model

Health care spaces and providers often focus on “men’s health” or “women’s health” specifically. Intake forms may have no option for declaring a gender identity separate from the sex assigned at birth. Health screening and insurance policies for diseases like cancer tend to remain geared to a flawed binary male-female model.

Gender-diverse patients often find themselves teaching their primary care doctors how to provide them with competent care, because many medical students get little training on providing gender-affirming care.

As a result, 1 out of 3 gender-diverse adults do not seek preventive care, according to a report by the National Center for Transgender Equality – or they are not offered these services at all – when they see a health care provider. Even more alarming, 19% of transgender folks report that they’ve been refused care altogether.

This may contribute to higher rates of tobacco use, obesity, alcohol use and other cancer risk factors in gender-diverse people.

Cancer care challenges

Research to date shows that transgender adults over age 45 are screened for colon cancer at a lower rate than cisgender patients. They are also more likely to be diagnosed at later stages of lung cancer. This can be devastating, because finding lung cancer before it spreads can literally mean the difference between life and death.

The University of California, San Francisco, one of the few places that has protocols for the care of transgender patients, recommends that transgender women who are older than 50 and have been taking a feminizing hormone for five years begin getting screened for breast cancer. However, according to a recent Canadian study, only about 1 in 3 transgender women who are eligible for breast cancer screening receive mammograms, compared with 2 in 3 eligible cisgender women.

In a 2021 study, researchers found that transgender patients with non-Hodgkin lymphoma, prostate cancer or bladder cancer had roughly twice the death rate of their cisgender counterparts. Since the researchers were able to firmly identify only 589 transgender individuals out of nearly 11.8 million records, they could not accurately compare rates for other types of cancer.

Since 2017, the American Society of Clinical Oncology has recommended including data about patients’ sexual and gender minority status in cancer registries and clinical trials. However, in 2022 the society found that only half of oncology care providers are routinely collecting gender identity information. So it’s clear that there’s still a lot to learn about the barriers to inclusive cancer care.

Lack of training in both medical school and residencies – intensive training stints where new doctors hone their skills – perpetuates these disparities.