Mixed sex wards and trans women.

Well, pretty much everything that is prescribed carries the risk of side effects but the doctor and patient weigh up the risks of taking the medicine or not taking it and decide whether to proceed. Taking the pill increases the risk of certain cancers (but appears to reduce the risk of others), for example, but for most low risk people that increased risk is better than an unwanted pregnancy. So I don't think it's a simple as not prescribing at all, I think there needs to be a better understanding of the different risk factors, which can only be achieved if proper data is collected that distinguishes between women and transwomen / men and transmen

if transgendered men on hormone therapy are at risk of developing breast cancer in an attempt to become something they are not (female) the doctor prescribing the hormones should stop doing so. It is a truly a crazy society where someone can receive damaging hormones and surgery from a doctor to treat correct the mental illness of gender dysmorphia.

Prawn and indeed many adult women are denied permanent sterilisation by their GPs, even when they are adamant that their family is complete, until they are in the 30s "in case they change their minds".

I would imagine that if it came to light that parents were obtaining illicit supplies of puberty blockers or cross sex hormones that this would be perceived as a safeguarding issue, though these days who can tell, we've gone so far down the rabbit hole. If parents have the money they can get them legally. The CEO of Mermaids obtained medication for her gay son by flying him to the US for prescriptions at 12 and flew him to Thailand for SRS at 16. People at Mermaids assure us the kid is very happy but is suspect many such individuals will experience profound regret as they mature.

While I agree that teenagers should have the right to obtain some forms of medical treatment, contraception for example, I don't think their wishes should extend to action that will sterilize them or cause lifelong physical changes. Girls on testosterone aren't always affected permanently but some find themselves stuck after only a few years with a bass voice, male pattern baldness and heavy male facial and body hair. A high price to pay for some serious teenage angst, and the fact that many lesbians don't recognize their sexuality until they reach their 20s.

We don't permit teenagers to opt for sterilization in any other context, and rightly so. I would have told you I was never going to have children right through until my 30s. Much of the medical treatment available to trans teenagers is, imo, far too risky to offer to immature brains.

I suspect the only illegality is if there is regarded as damage to the child. I tend to favour parental freedom until children are more like 13 - 15 when they should have a lot more say in making their own decisions.

Surely it is illegal to purchase medicines off the internet and to administer them to a child without a prescription, or worse still off-license when there is ZERO safety data? I think I read that the puberty blockers that are used on children are actually chemotherapeutic drugs that were developed to suppress the pituitary gland's production of hormones fuelling a tumour. Would any parent feel comfortable "free-styling" their own chemo regimen for their child without medical guidance or regular monitoring? For parents found to be administering puberty blockers outside of medical supervision, I think care proceedings would be entirely appropriate. I also have a view on doing so under medical supervision, but hey ho...

YY to that. Everyone deserves decent healthcare, and it would seem obvious to me that careful statistics be kept on trans individuals taking prescribed hormones or postoperatively. We need to know the long-term risks.

But from what I've read, a lot of trans people, impatient with gate keeping, are obtaining meds online without prescription. This is either instead of official prescriptions or as well as. Elsa told us about other parents encouraging her to get online blockers for her child during her time with Mermaids.

If there are enough trans people taking meds that haven't been prescribed it will be difficult to measure long term outcomes of them as a patient group. You don't even know who you're measuring. It'll be more like research into the use of street opiates, which can never be accurate.

Still, I guess that the patients who only take what they've been prescribed can be followed up. I find the fact that children are being given medication off-label very concerning.

Collecting that kind of longitudinal data is so important for optimising health outcomes and reducing harm it seems madness to not have a meaningful way of tracking trans health interventions.

I agree Wanking. There just isn't a reasonable sized longitudinal data set at the moment. Because I'm not in fact a nasty transphobe who wishes ill on others, I would have thought it would be really useful to know if (for example, completely made up theories) using puberty blockers increased the risk of cervical cancer in transmen to the extent that they should consider a total hysterectomy; or long term hormone use was safe for transwomen for 15-20 years but after 20+ years the risk of developing breast cancer and osteoporosis shot up. Or indeed if there are any unexpected side effects of long term hormone use that could have therapeutic benefits elsewhere, or simply if there is an optimum time to begin a physical transition to minimise the long term risks.

Once every 3 years is proof enough that their risk is lower. Most women are told to have mammographies once every 2 years

The breast screening programme in the UK for women aged between 50-70 is screening every three years.

Also trans people need seperate stats gathered in order to fully determine the effects of long term hormone use and stuff. We will never know if its actually safe or increases risks of certain diseases significantly if we just pretend that trans people actually are their 'chosen' sex.

I worry a bit about transwomens medical stats being put down as female. Could very well mean stats on things such as cervical cancer are wrong and lose funding as a drop is shown and so on..and tats not as crazy as it sounds, transwomen are actually invited for smear tests :/

Same with crime stats. Violence committed by women will be on the rise with the rising number of people who 'identify' as trans.

Should have previewed my post. Suffice it to say, there is lots of useful data on the Cancer Research UK site with male/female splits (sex, not gender...)

According to [[http://www.cancerresearchuk.org/sites/default/files/cstream-node/inc_asr_gb_f_breast_2.pptCancer Research UK stats for male breast cancer]] the UK male incidence is ~1.3 per 100,000 versus about 165 per 100,000 in women For a screening service to be cost effective, you need to be detecting and treating tumours early enough individuals to reduce mortality & morbidity. Effective screening schemes also need high levels of uptake, which is why there is no digital rectal prostate screening programme (patient acceptability is a factor - there was a review in the 90s.) It seems from the Dutch study above that transwomen's rates are little higher than men's & we do not routinely screen men. Ergo, we should not routinely screen transwomen for breast cancer. Regular self-examination & vigilance is likely to be more effective for transwomen TBH.

There's also the old chestnut about HCPs: can I refuse to have my mammogram performed by a transwoman?

One hopes that the data for women and transwomen is recorded separately re incidence of breast cancer, so that trends can be reviewed and the effectiveness of the current screening programs considered. In other words, transwomen are shooting themselves in the foot if it turns out that they do have an enhanced risk of breast cancer after, say, 20 years on hormone therapy that requires a different screening schedule, but that information is completely obscured because it has been lumped in (clumsy pun not intended) with the data on women.

Was there a part of my post that you didn't understand?

Yes, there is a breast cancer risk for transwomen after many years of HRT. No, it is not 'the same risk" as that of women, which was your erroneous claim.

Once every 3 years is proof enough that their risk is lower. Most women are told to have mammographies once every 2 years, and some with higher risk do it every year.

Still enough of a risk to offer them 3 yearly screening mammograms.

"Those that are on hormones will have breast tissue the same as women. Therefore have the same risk of developing breast cancer."

Not true.

A retrospective study of 2,307 Dutch transgender women treated at a single center found an estimated incidence of 4.1/100,000 person-years, in comparison to the incidence of 155/100,000 person-years in the general Dutch non-transgender female population. (From here.

Yes, they will have a risk (and that after 5-10 years on HRT) but it is nowhere near the same as women's.

But MtT ARE invited for screening. Those that are on hormones will have breast tissue the same as women. Therefore have the same risk of developing breast cancer.

Of course.

So there would be no need for a MtT to attend a screening unit. The point is therefore moot.

Men don't get offered screening for breast cancer.

I wonder where men get their breast cancer screening done then?

Given the small number of men who get breast cancer I know three, I might ask them, but I suspect it's in hospital rather than mobile units.

You are left alone with other patients. Two mammographers on the mobile unit (in my area anyway) one is interviewing a patient in a quiet room and the other is x-raying at the same time.

I have never been in a mobile screening unit (always did my mammographies at the hospital) but I don't believe that you are ever alone with any other patient at any . So not at all comparable to female changing space of a swimming pool, female toilets, or any other female-only safe area.