Clinically reviewed by Haley Collins, NP
Your preventive care should be based on the body you have, the care you’ve received, and your actual risk factors—not the gender marker in your chart.
Figuring out which health screenings you need can be surprisingly confusing when most guidelines still start with “men should…” and “women should…”
For LGBTQ+ people, that framework can fall apart pretty quickly. You might have a cervix but not identify as a woman. You might have breast tissue because you take estrogen. You might have had top surgery but still have some breast tissue. You might have a prostate and have been taking estrogen for decades. And your sexual health screening should depend on what kinds of sex you’re actually having—not what your provider assumes from your identity.
That’s assuming that you have a relationship with a provider at all and that you’re getting annual screenings….which we know many of us aren’t.
So instead of trying to fit yourself into the wrong checklist, here’s a better way to think about preventive care.
First: screen the body you have
The simplest rule is this:
If you have an organ or body part, it may need screening—even if it isn’t typically associated with your gender.
Gender-affirming hormones usually don’t make those screening needs disappear. Surgery sometimes does, depending on what tissue was removed. Your age, family history, medications, sexual exposures, smoking history and other health conditions can all change the plan, too.
That organ-based approach is also recommended in transgender primary care guidance.
And one important distinction: screening is for people who don’t have symptoms. If something feels different—new bleeding, a lump, persistent pain, a change in bowel habits, unexplained weight loss or another concerning symptom—you may need diagnostic testing regardless of your age or screening schedule.
Your quick preventive screening timeline
Starting in adulthood
There are a few things virtually everyone should have on their preventive-care radar.
Blood pressure: All adults 18 and older should be screened for high blood pressure.
Mental health: Routine depression screening is recommended for adults, including during pregnancy and postpartum.
HIV: Everyone should be tested at least once, with repeat testing based on exposure and risk. The USPSTF specifically recommends routine screening from ages 15–65 and testing outside that range when risk is higher.
Hepatitis B: CDC now recommends that every adult 18 and older be screened at least once using a hepatitis B “triple panel.” Some people should be tested periodically if exposure risk continues.
Hepatitis C: Every adult should be screened at least once, with repeat testing for people with ongoing risk.
STIs: There isn’t one universal LGBTQ+ schedule. Testing should be based on your anatomy, sexual practices, partners and sites of exposure.
That last point matters. A urine test alone, for example, won’t necessarily detect an infection in your throat or rectum. Depending on how you have sex, you may need genital, rectal and/or throat testing. For some sexually active gay and bisexual men and others with similar exposures, CDC recommends screening at least annually and as often as every 3–6 months when risk is higher, including for some people taking PrEP.
In your 20s: cervical screening and HPV prevention
If you have a cervix
You need cervical cancer screening regardless of whether you’re a woman, man, nonbinary person or any other identity.
Exactly when to start varies somewhat by guideline. Current American Cancer Society guidance recommends beginning at age 25 for average-risk people with a cervix. Screening options include:
- A clinician-collected primary HPV test every 5 years
- A self-collected HPV test every 3 years when an approved option is available
- HPV + Pap co-testing every 5 years
- A Pap test alone every 3 years when HPV testing isn't available
Other U.S. guidelines have historically started screening at age 21, so your clinician may recommend a somewhat different schedule.
Taking testosterone does not mean you can skip cervical screening.
Testosterone can change cervical and vaginal tissue, however, and Pap samples are more likely to come back inadequate in people taking testosterone. Pelvic exams can also be uncomfortable or dysphoric. Tell your clinician that you use testosterone, and ask about options that can make screening easier—including self-collected HPV testing when appropriate.
And yes: you still need cervical screening if you only have sex with women, if you aren't currently sexually active or if you received the HPV vaccine.
HPV vaccination
HPV can cause cervical, anal, penile, vaginal, vulvar and some head and neck cancers.
HPV vaccination is recommended for everyone through age 26 who wasn't adequately vaccinated earlier. For people ages 27–45, vaccination can still make sense depending on your history and likelihood of future HPV exposure, so it’s worth discussing with a clinician.
Starting at 40: think about breast and chest cancer screening
This is one area where anatomy, surgery and hormones all matter.
If you have breast tissue and haven't had top surgery or a bilateral mastectomy
For people assigned female at birth at average risk who still have breast tissue, the USPSTF recommends mammograms every two years from ages 40–74.
That includes trans men and nonbinary people who have not had their breast tissue removed.
Your screening plan may need to start earlier or include MRI if your risk is higher because of factors such as:
- A BRCA1, BRCA2 or other cancer-related genetic variant
- A strong family history of breast or ovarian cancer
- Previous breast cancer or certain high-risk breast biopsies
- Radiation to the chest at a young age
If you've had top surgery
Top surgery significantly changes breast anatomy, but it usually does not remove every breast cell.
There isn't enough evidence to recommend routine mammograms after bilateral masculinizing mastectomy, and mammography may not even be technically possible depending on the surgery. New lumps, chest-wall changes or other symptoms should still be evaluated. Some individuals may decide to complete breast MRI after masculinizing top surgery if they have a strong family history of breast or ovarian cancer. This is where shared-decision making with your clinician comes into play.
If you take estrogen
Long-term estrogen exposure creates breast tissue and can change screening recommendations.
There is less research on optimal screening for transfeminine people than there is for cisgender women, so guidelines vary. The American College of Radiology says mammography may be appropriate starting at age 40 for average-risk transfeminine people who have had at least five years of past or current feminizing hormone exposure. Higher-risk people may need screening earlier.
This is one screening area where an individualized conversation with a clinician is particularly important.
Starting at 45: colorectal cancer screening
Colon cancer screening is refreshingly ungendered.
Everyone at average risk should start colorectal cancer screening at age 45.
You have options, including at-home stool tests and colonoscopy. The right frequency depends on which test you choose.
Routine screening generally continues through age 75. From 76–85, the decision becomes more individualized based on your overall health and previous screening history.
You may need to start earlier if you have a strong family history, inflammatory bowel disease, certain genetic syndromes or previous abnormal polyps.
What about anal cancer screening?
Anal cancer screening is not currently recommended universally—but some LGBTQ+ people have substantially higher risk.
Newer expert guidelines recommend anal cancer screening beginning at:
- Age 35 for gay, bisexual and other men who have sex with men and transgender women living with HIV
- Age 45 for other people living with HIV
- Age 45 for gay, bisexual and other men who have sex with men and transgender women without HIV
Screening may also be considered for some people with previous HPV-related precancer or cancer, persistent high-risk HPV, perianal warts, organ transplants or certain immune conditions. Availability of anal Pap testing and high-resolution anoscopy varies considerably.
If this applies to you, ask your clinician specifically about anal cancer screening—it may not automatically appear in a standard preventive-care checklist.
Starting around 50: lung cancer screening if you have a significant smoking history
Routine chest X-rays don't screen effectively for lung cancer.
Instead, annual low-dose CT scans are recommended for adults ages 50–80 who:
- Have at least a 20 pack-year smoking history, and
- Currently smoke or quit within the past 15 years
A pack-year means the equivalent of smoking one pack per day for one year.
LGBTQ+ communities have historically experienced higher rates of tobacco use, which makes this one worth actively checking rather than assuming it doesn’t apply to you.
If you have a prostate
Gender-affirming estrogen, androgen blockers and orchiectomy do not usually remove the prostate.
That means trans women and other transfeminine people can still develop prostate cancer.
For average-risk people, the USPSTF recommends an individualized conversation about PSA screening from ages 55–69 rather than automatically testing everyone. Routine screening isn't recommended after age 70 under USPSTF guidance. Family history and other risk factors can change that conversation.
There’s another important wrinkle for people taking estrogen or androgen-lowering medications: those treatments can lower testosterone and PSA levels, which may affect how results are interpreted. Make sure the clinician interpreting your PSA knows about your hormone therapy.
Around 65: don't forget bone health
Hormones matter quite a bit here because both estrogen and testosterone help maintain bone density.
The USPSTF recommends routine osteoporosis screening for cisgender women 65 and older and earlier screening for postmenopausal people at increased fracture risk. Evidence is less definitive for routine screening in other populations.
For trans and nonbinary people, clinicians may also consider earlier bone-density testing if you have additional risk factors—particularly if you've had your ovaries or testes removed and then spent a significant period of time without adequate sex-hormone replacement. UCSF guidance recommends considering bone-density screening in people who have gone at least five years without hormones after gonadectomy.
Other factors like smoking, long-term steroid use, low vitamin D, HIV, certain chronic illnesses and previous fractures can also raise your risk.
Hormones change some screening decisions—but they don't replace preventive care
If you're taking gender-affirming hormones, it's easy to think of your regular hormone labs as your annual health check.
They're not quite the same thing.
Monitoring testosterone, estrogen, blood counts or electrolytes helps make sure your medication is working safely. Preventive screening looks for health problems that may have nothing to do with your hormones. Keep in mind that the blood tests you have done as part of your gender-affirming hormone therapy plan may not be all of the blood tests recommended for your age or risk profile.
Think of them as two overlapping parts of your care.
A few rules of thumb:
If you're taking testosterone: You still need cervical screening if you have a cervix and breast screening if you have enough breast tissue to meet screening criteria.
If you're taking estrogen: Your breast cancer screening plan may change after several years of estrogen exposure, while prostate screening can still be relevant if you have a prostate.
If you've had your ovaries or testes removed: Staying adequately hormonally supported matters for bone health unless there's a medical reason you can't take hormones.
If you've had gender-affirming surgery: Know exactly which organs and tissues were removed. A hysterectomy, for example, may or may not include removal of the cervix. “Top surgery” can mean different procedures with different amounts of residual breast tissue.
Risk can move your screening timeline earlier
Age-based recommendations are designed for people at average risk. Your plan may be different if you have:
- A parent, sibling or child who developed cancer at a young age
- Multiple relatives with the same or related cancers
- A known genetic cancer syndrome
- HIV or another condition affecting your immune system
- Previous cancer or precancer
- Prior radiation treatment to your chest
- A history of smoking
- Inflammatory bowel disease
- Ongoing sexual exposures that increase your risk for HIV, hepatitis or other STIs
- A history of organ transplant
- Long periods without estrogen or testosterone after gonadectomy
That’s why “What screenings am I due for?” is often a much better question than “What screenings do people like me get?”
What your clinician actually needs to know
You shouldn't have to tell your entire life story just to get appropriate preventive care.
But a clinician building your screening plan should know:
- Which organs you currently have
- Which surgeries you've had
- Which hormones or hormone blockers you use and for how long
- Your personal and family cancer history
- Your last major screening tests and results
- What kinds of sexual contact you have and which body sites are exposed
- Your smoking history
- Relevant medications and health conditions
- Your HPV and hepatitis vaccination history
None of those answers require making assumptions about your identity.
And that’s really the point.
Good LGBTQ+ preventive care isn't a separate set of mysterious rules. It's good preventive care that actually takes your body, your life and your risks into account.
At FOLX, our clinicians understand LGBTQ+ bodies and lives—and can help you figure out what you're due for, what you can skip, and what may need a more individualized plan.
This guide is intended for general educational purposes and primarily reflects recommendations for average-risk adults in the United States. Screening guidelines change over time and recommendations may differ among medical organizations. Your personal screening schedule may be different based on your medical history, anatomy and risk factors.
