Embarking on gender-affirming care while undergoing treatment for cancer presents unique challenges and considerations. This situation requires a delicate balance between respecting personal gender identity goals and addressing the medical complexities associated with cancer, particularly hormone-dependent cancers.

Hormone-Dependent Cancers and Hormone Therapy

For individuals with hormone-dependent cancers, such as certain types of breast or prostate cancer, hormone levels play a critical role in the progression of the disease. These cancers are typically treated with hormone suppression therapy:

• Standard Hormone Suppression Advice: For these cancers, standard medical advice generally involves suppressing hormones that could fuel cancer growth. This may include limiting estrogen in some breast cancers or testosterone in certain prostate cancers.
• Impact on Gender-Affirming Hormone Therapy: Starting hormone therapy that contradicts cancer treatment (like introducing estrogen in a case where estrogen needs to be suppressed) could potentially exacerbate the cancer. Therefore, people with hormone-dependent cancers are usually advised against starting gender-affirming hormone therapy that increases these hormones.

Understanding and Supporting Personal Goals

For transgender individuals with cancer, particularly those who may have a shortened life expectancy, understanding and respecting their personal goals and identity is crucial:

• Personalised Approach: Each individual’s situation is unique, and their treatment should reflect their personal goals and life circumstances.
• Support and Respect: Healthcare providers should offer empathetic support, understanding that the desire for gender-affirming care is a significant aspect of the individual’s identity and quality of life.
• Informed Decision-Making: People should be fully informed about the implications of starting gender-affirming hormone therapy alongside cancer treatment, including potential risks and benefits.

Non-Hormonal Gender-Affirming Options

For those who cannot pursue hormone therapy due to cancer treatment, other gender-affirming options may be considered:

• Surgical Interventions: Depending on the type and stage of cancer, surgical options for gender affirmation might be available.
• Psychological Support: Counseling and therapy can provide significant support in navigating gender dysphoria during cancer treatment.
• Social Transition: Aspects of social transition, such as name changes, pronoun use, and gender expression through clothing and appearance, can be powerful gender-affirming steps.

Managing Drug Interactions

• Vigilant Monitoring: If a person is receiving both cancer treatment and gender-affirming care, careful evaluation for drug interactions is needed.
• Coordination of Care: A multidisciplinary approach involving oncologists, endocrinologists, and other relevant healthcare professionals is crucial for safe and effective treatment.

Conclusion

Starting gender-affirming care while undergoing cancer treatment is complex, especially in the context of hormone-dependent cancers. It requires a careful, person-centered approach that balances medical safety with respect for the individual’s gender identity and life goals. Open communication, multidisciplinary care, and compassionate support are key to navigating these challenges and supporting transgender individuals through their cancer treatment journey.