nhs england gender reassignment policy

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• NHS England

NHS population screening: information for trans and non-binary people

Updated 4 January 2023

Applies to England

© Crown copyright 2023

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] .

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This publication is available at https://www.gov.uk/government/publications/nhs-population-screening-information-for-transgender-people/nhs-population-screening-information-for-trans-people

This information is for trans (transgender) and non-binary people in England. It tells you about the adult NHS screening programmes that are available in England and explains who we invite for screening.

We use trans as an umbrella term to embrace the diverse range of identities outside the traditional male/female definitions. These include transgender, gender fluid and non-binary. Find more trans health information on NHS.UK .

Screening for trans people at a glance

Trans women and non-binary people assigned male at birth who are registered with a GP as female:

• are invited for breast screening
• are invited for bowel cancer screening
• do not need cervical screening as they do not have a cervix
• are not routinely invited for abdominal aortic aneurysm ( AAA ) screening but can request screening

Trans women and non-binary people assigned male at birth who are registered with a GP as male:

• are not routinely invited for breast screening but can request screening
• are invited for AAA screening

Trans men and non-binary people assigned female at birth who are registered with a GP as female:

• are invited for cervical screening
• are not invited for AAA screening

Trans men and non-binary people assigned female at birth who are registered with a GP as male:

• are not routinely invited for cervical screening but can request screening
• are invited for AAA screening but do not have a high risk of AAA

Trans men who are pregnant should be offered the same antenatal and newborn screening tests as all other pregnant individuals.

Breast screening

Breast screening is a free NHS test that is carried out at breast screening centres and at mobile breast screening units across England.

Breast screening can find cancers when they are too small to see or feel. Finding and treating cancer early gives you the best chance of survival. Screening will miss some cancers, and some cancers cannot be cured.

Taking part in breast screening is your choice. You can find out more information from your GP or by visiting NHS.UK .

Breast screening invitation process

All individuals from 50 up to their 71st birthday who are registered as female with their GP are automatically invited to breast screening. When you are due for screening, we will send you an invitation letter. It is not possible for individuals registered as male to have mammograms as part of the NHS Breast Screening Programme, but your GP can refer you for mammograms at a hospital near you (see the information for people registered as male below).

We invite you for breast screening every 3 years. Your first invitation will arrive sometime between the ages of 50 and 53. If you are trans it is important that your GP makes sure that your records are up to date so you are invited for screening correctly.

If you do not want to be invited for breast screening, you need to contact your local breast screening office. They will explain how you can opt out of breast screening.

It is important that you feel that you are treated with dignity and respect at all times.

Let your screening service know if you would:

• like your appointment at the beginning or end of a clinic
• prefer to be screened at your local breast screening centre rather than a mobile breast screening unit

Visit NHS.UK for your service’s contact details.

Trans men and non-binary people assigned female at birth

Registered with a gp as female.

If you are aged from 50 years up to your 71st birthday and registered with a GP as female, you will be routinely invited for breast screening. We recommend you consider having breast screening if you have not had chest reconstruction (top surgery) or still have breast tissue.

If you are worried about visiting a breast screening unit you can ring to arrange a more suitable appointment. For example, we can arrange for you to have an appointment at the beginning or end of a clinic.

Registered with a GP as male

If you are registered with a GP as male, you will not be invited for breast screening. If you have not had chest reconstruction (top surgery) and are aged 50 or over we suggest you talk to your GP . They can arrange a referral for you to have mammograms at a hospital near you.

You should keep aware of the symptoms of breast cancer , and contact your GP if you notice any unusual changes.

If you have had chest reconstruction (top surgery), we advise you have a conversation with your surgeon about the amount of breast tissue you have remaining. If they confirm you still have breast tissue, you can ask your GP to refer you for mammograms at a hospital near you.

Trans women and non-binary people assigned male at birth

Registered with a gp as a female.

If you are aged from 50 up to your 71st birthday and registered with a GP as female, you will be routinely invited for screening. Long-term hormone therapy can increase your risk of developing breast cancer so it is important that you consider going for breast screening when you are invited.

If you are registered with a GP as male, you will not be invited for breast screening.

If you have been on long-term hormone therapy you may be at increased risk of developing breast cancer. Your GP can arrange a referral for you to have mammograms at a hospital near you.

Breast screening test

A breast X-ray called a mammogram is used to look for signs of cancer. Each breast is pressed firmly between the plates of an X-ray machine for a few seconds. The pressure is needed to get good images and also reduce the radiation dose. Your test will be carried out by a specially trained female mammographer.

Some people say having a mammogram is uncomfortable and a few may find it painful, but the discomfort should pass quickly.

Breast screening usually involves 2 X-rays of each breast. People who have implants are offered the choice of additional X-rays so the mammographer can see as much breast tissue as possible.

Preparation

If you are a trans man or non-binary person assigned female at birth who is registered with a GP as female, has not had chest reconstruction (top surgery) and wears a binder, you will need to remove this before having your mammogram.

Private changing facilities will be available so that you can remove your binder just before having your mammogram. If you have any concerns about your appointment, you can contact your local breast screening service.

Breast screening results

For most people the mammograms will show no signs of cancer. If changes are seen on your X-rays, you will be recalled to an assessment clinic for more tests which will include:

• a breast examination
• more X-rays or ultrasound scans

You may also have a biopsy, where a small sample of tissue is taken from the breast with a needle.

Sometimes breast screening can pick up cancers that would never have caused harm, so people are treated for breast cancer that would never have been life-threatening.

Reducing your risk

Screening reduces the number of deaths from breast cancer by finding signs of disease at an early stage.

It is important to know what is normal for your body. If you notice any changes report them to your GP .

Cervical screening

Cervical screening (also known as a smear test) is a free NHS test that is carried out at your GP surgery or at some sexual health clinics. The test looks for early changes in the cells of the cervix.

Cervical screening aims to prevent cancer from developing in the cervix (neck of the womb).

It is important to go for screening as finding changes before they become cancer gives you the best chance of successful treatment.

Nearly all cervical cancers are caused by human papillomavirus ( HPV ). HPV is a very common virus – most people will be infected with it at some point in their life. It can be passed on through any type of sexual activity.

Screening will not prevent all cancers and not all cancers can be cured.

Taking part in cervical screening is your choice. You can find out more information from your GP or by visiting NHS.UK .

Cervical screening invitation process

We invite people registered as female for cervical screening every 3 years from the age of 25 to 49 and every 5 years from the ages of 50 to 64. We also invite people who are over 65 who have not been screened since age 50 or those who have recently had abnormal tests.

We send an invitation letter when the cervical screening test is due, asking you to make an appointment.

If you are trans it is important that your GP contacts the NHS Cervical Screening Programme so you are invited for screening correctly. If you do not want to be invited for screening you should contact your GP . They will be able to remove you from the cervical screening invitation list.

It is important that you feel that you are treated with dignity and respect at all times. If you are worried about having cervical screening, talk to your doctor or practice nurse.

If you are aged 25 to 64 and registered with a GP as female, you will be routinely invited for cervical screening. We recommend that you consider having cervical screening if you have not had a total hysterectomy and still have a cervix.

If you are aged 25 to 64 and registered with a GP as male, you will not be invited for cervical screening. However, if you have not had a total hysterectomy and still have a cervix, you should still consider having cervical screening. This is especially important if you have had any abnormal cervical screening results in the past. If this applies to you, let your GP or practice nurse know so you can talk to them about having the test.

If you are a trans woman or non-binary person assigned male at birth, you will not need to be screened as you do not have a cervix.

If you are registered with a GP as female, you will be routinely invited for cervical screening unless your GP has already told us you’re not eligible. We can update our records so you are not invited unnecessarily.

If you are registered with a GP as male, you will not be invited for cervical screening.

Cervical screening test

The nurse or doctor will put an instrument called a speculum into the vagina to help them see the cervix. They will then take a sample of cells with a soft brush.

If you are a trans man who has taken long-term testosterone, you may find screening uncomfortable or painful. You may want to talk to your doctor or nurse about using a different size speculum and some extra lubrication.

Cervical screening results

For most people their test results are normal. If cell changes are found you may need another cervical screening test, or an appointment at a colposcopy clinic where the cervix is looked at in detail.

Nearly all cervical cancers are caused by a virus called human papillomavirus ( HPV ) which is passed on through any type of sexual activity. If you are worried about your risk of developing cervical cancer you may want to speak to your GP or practice nurse.

We recommend you consider going for cervical screening every time you are invited, even if you have had a previous normal result.

Let your GP or practice nurse know if you think you should be invited for screening.

Even if you have had the HPV vaccine we still recommend you consider going for cervical screening when invited.

Consider stopping smoking, as smoking increases your risk of cervical cancer.

If you have symptoms such as unusual vaginal discharge or bleeding, or pain during or after sex, please speak to your doctor even if you have had a normal cervical screening result.

AAA screening

AAA screening is a free NHS test that is carried out in the community, including hospitals, health clinics and GP practices.

AAA screening involves a simple ultrasound scan to measure the abdominal aorta.

The aorta is the main blood vessel that supplies blood to the body. Sometimes the wall of the aorta in the abdomen can become weak and stretch to form an abdominal aortic aneurysm ( AAA ). There is a risk that an AAA may split or tear (rupture).

There is a high risk of dying from a ruptured AAA . Finding an aneurysm early gives you the best chance of treatment and survival. AAA screening reduces your risk of dying from a ruptured AAA .

Taking part in AAA screening is your choice. You can find out more information about AAA screening from your GP or by visiting NHS.UK .

AAA screening invitation process

AAAs are far more common in men aged over 65 than in women and younger men. That’s why the NHS AAA Screening Programme only invites for screening individuals registered as male. However, any trans woman will have the same risk as a man and should consider accessing screening.

Individuals registered as male are invited for an ultrasound scan to check the size of their abdominal aorta when they are 65.

Individuals over 65 can request a scan by contacting their local AAA screening service directly. Visit NHS.UK for contact details.

If you are trans it is important that your GP contacts the NHS AAA Screening Programme so you are invited for screening correctly. If you do not want to be invited for AAA screening, you will need to let us know.

If you are not sure if you should be screened or not, contact your local screening office. You will find your local screening office number and more information about clinic locations on NHS.UK .

Trans men and non-binary people assigned female at birth do not have the same risk of AAA as people assigned male at birth.

If you are registered with a GP as female, you will not be invited for AAA screening.

If you are a trans man aged 65 who is registered with a GP as male, you will be sent an appointment to attend for AAA screening. You can have AAA screening if you wish even though your risk is lower. If the clinic location or appointment time is not suitable, you can contact your local screening office to change this. You will find your local screening office phone number on your invitation letter.

If you are registered with a GP as female, you will not be invited for screening. However, if you are 65, you will have the same risk as a man aged 65 and should consider accessing screening. You can contact us to arrange a suitable appointment. Visit NHS.UK for contact details.

If you are aged 65 and registered with a GP as male, you will be invited for AAA screening.

Any trans woman or non-binary person assigned male at birth will have the same AAA risk as a man and should consider accessing screening.

AAA screening test

The test is a simple ultrasound scan of your abdomen to measure the size of the aorta. Your screening appointment usually takes about 10 to 15 minutes.

The screener will check your personal details and ask for your consent (permission) to do the ultrasound scan.

You will be asked to lie on your back and lift up your top. You will not need to undress completely. If you are wearing a binder, you may be asked to remove it.

The ultrasound scan is usually painless. It can be slightly uncomfortable as the screener may need to apply some pressure.

AAA screening results

The screener will give you your results following your scan.

It is not always possible to see your aorta at your screening test so you may be referred to hospital.

If your aorta is found to be bigger than normal, you will need regular scans to check if it is growing. Some people never need surgery for their AAA .

If your AAA is large you will be referred to a specialist team to discuss planned surgery. Large AAAs can be treated successfully with surgery.

Consider taking part in AAA screening and follow-up when you are invited.

You should also consider:

• stopping smoking
• drinking less alcohol

It is also important to maintain a healthy weight through a healthy diet and physical activity.

Bowel cancer screening

Bowel cancer screening starts with a test kit that is offered for use at home. If the result shows further tests are needed, you are offered a colonoscopy (an examination of the bowel).

Bowel cancer screening reduces your risk of dying from bowel cancer.

Finding cancer early gives you the best chance of survival.

Screening will miss some cancers, and some cancers cannot be cured.

Taking part in bowel cancer screening is your choice. You can find out more information from your GP or by visiting NHS.UK .

Bowel cancer screening invitation process

Both men and women are routinely invited for screening.

Bowel cancer screening is offered every 2 years from the ages of 60 to 74. This age range is gradually being extended down to age 50. People aged 75 and over can request a test kit every 2 years by calling the free programme helpline on 0800 707 60 60.

The home test kit

A bowel screening test kit and information pack will be sent to you when you are due for screening. You are asked to collect one or more samples of your poo using the test kit provided.

You will need to complete the test kit within the timeframe on the instructions and return it using the freepost packaging provided.

The test looks for tiny amounts of blood in the sample which you may not be able to see and which could be a sign of bowel cancer. You can contact the free NHS Bowel Cancer Screening Programme helpline for advice on 0800 707 60 60.

Results from the test kit

If blood is found, you will be referred for further tests. This may involve you having a colonoscopy, which looks at the lining of the bowel using a flexible camera. You may find this more uncomfortable if you have had gender reassignment surgery.

To reduce your risk of bowel cancer you should:

• consider taking part in screening, even if you have had a previous normal result
• try to eat a high-fibre diet with plenty of fruit and vegetables, take regular physical exercise and stop smoking
• visit your GP if you notice blood in your poo, a change in your bowel habit over a number of weeks or unexplained weight loss

Bowel cancer can run in families. If you are worried about your risk please speak to your GP .

Your personal information

It is your decision whether or not to have any of these tests.

The NHS Screening Programmes use personally identifiable information about you to ensure you are invited for screening at the right time. NHS England also uses your information to ensure you receive high quality care.

Find out more about how your information is used and protected, and your options . Find out how to opt out of screening .

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Service specification: Gender Identity Services for Adults (Surgical Interventions)