opinion

Putting the ‘T’ in breast health

As a transgender woman I always have to take the time to find the right doctor who understands my specific needs. Transgender health can be a tricky topic and we need educated care providers. But when it came to my breast health, I just needed to find someone who would take me as a client. I am older than 45 and it was time for my second mammogram . And as I am challenged financially, I had to go the public health route.

A few years back when my primary caregiver suggested I use a program called “Wise Women” for my breast health, I was thrilled, as the program is set up for women to access breast care. What I did not factor in was that those programs did not serve transgender women.

Back then I made my appointment and jumped through the public health system hoops to find myself sitting in an exam room with a nurse asking me when my first menstrual cycle was, when my last menstrual cycle and when I wanted a pap smear. It was embarrassing for us both once I told her that none of those things apply as I am transgender. The look on her face was of disappointment as she explained that the breast health program was only for women who were born female. It had to do with policy and procedure on a state level and these programs just could not help me.

Because there is not nearly enough research on how transgender people are affected by breast cancer, I was concerned because of breast cancer in my family. Those who work on transgender health note the following:

For a transgender woman, the risk of breast cancer increases following breast development and five or more years of hormone therapy.

For a transgender man, excessive testosterone can be converted into estrogen by the body, which leads to increased cancer risk. Additionally, transgender men may not realize that top surgery does not remove all breast tissue. Self-examination is a useful prevention tool that can be life saving, regardless of a person’s gender.

Breast cancer in transgender and transsexual patients is rarely reported, and when it is, it is often in association with hormonal therapy and mentioned as a potential side effect of that therapy, particularly with estrogen.

I grew my breast as any other woman did and never felt the need for implants, basically what I have is mine and breast tissue is breast tissue, but for years I have been trying to educate care givers on the needs of my community. The biggest challenge has always been with accessing breast-health care.

Recently I decided to try again to access care through the “Wise Women” programs. I made the call and explained I was in need of a mammogram and that I was pretty sure I would qualify with my financial issues. I then explained I was a transgender woman and to my surprise I was told that was fine and we finalized my appointment time.

I went in to the new location for Buncombe County Health Clinic at 53 French Broad Ave. downtown and was nervous at first. I am fortunate that I blend in pretty well and took care of my name change and gender marker many years ago, which is a huge barrier for others in my community when trying to access care.

I went into the exam room with a nursing assistant to begin the process and was asked the same questions that a few years ago led me to “out” myself as transgender. But to my surprise I was told being transgender was not an issue and that the state changed those policies a few months back. After a respectful physical exam of the breast tissue by the nurse practitioner, I was waiting for the confirmation of my mammogram appointment with the new Mission Imaging.

I am happy to say that finally after years of being refused service, North Carolina changed its policy and procedure in regard to these programs and anyone with breasts can access care. If you are older than 40 and have concerns about your breast health, I recommend you contact Wanda with the Breast and Cervical Cancer Control Program at Buncombe County Health and get an appointment.

Jennifer M. Barge is a transgender educator, HIV/AIDS activist and director of TransHealth Coordinators — a national nonprofit based in Asheville.