There are screening guidelines for hereditary gynecologic cancers to aid with prevention and early detection of these cancers, however, there are no clear guidelines for those patients that are transgender. This case report describes management of two distinct female-to-male transgender patients with hereditary cancer syndromes.METHODS:
The clinical cases were analyzed followed by literature review of transgender patients undergoing screening and management of hereditary cancer syndromes.RESULTS:
A 28-year-old female-to-male transgender patient presented with a new diagnosis of Lynch Syndrome with a known MLH1 mutation. Secondary to his low socioeconomic status, he had not been able to access transgender health resources. Traditional work up for Lynch syndrome were bypassed secondary to being a vaginal virgin. He was planned for a hysterectomy and bilateral salpingectomy with possible oophorectomy, secondary to the patient not potentially having future resources for hormonal replacement. In contrast, a 19-year-old female-to-male transgender patient presented with a known BRCA 2 mutation. He has been engaged in counseling regarding gender issues and has been receiving testosterone injections since the age of 16. At age 17, he underwent a prophylactic mastectomy for risk reduction. At the age of 18, he underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy.CONCLUSION:
This is the first body of research to our knowledge describing management of gynecologic hereditary cancer syndromes in transgender patients. Considerations that need to be taken into account on an individualized basis include the patient’s desire to undergo gender-affirming surgery, resources for obtaining hormonal replacement, future fertility, and comfort level for pelvic exams.