Annual Exam for Transmasculine Nonbinary Person Requesting Gender-Affirming Hormone Therapy

Combining Annual Exam with Hormone Therapy Initiation

The American College of Physicians recommends a multidisciplinary approach that addresses both physical health needs and gender-affirming treatment in an integrated manner, and gender-affirming care should not be artificially separated from routine preventive care 1
There is no medical reason to delay hormone therapy initiation if the patient is ready and there are no contraindications, according to the Mayo Clinic 1

Document an organ inventory regardless of gender identity to ensure appropriate preventive care, as recommended by the American Medical Association 1
Take a detailed menstrual history if applicable, including whether dysmenorrhea or menorrhagia is present, as these symptoms can severely exacerbate gender dysphoria, according to the American College of Obstetricians and Gynecologists 1

STI screening questions are essential and should NEVER be skipped based on assumptions about sexual activity or risk, as stated by the Centers for Disease Control and Prevention 1
Use inclusive, non-judgmental language when asking about sexual partners and practices to ensure accurate risk assessment, as recommended by the American Sexual Health Association 1

A bimanual exam should NOT be performed routinely "regardless of complaints," and pelvic examination should only be done when clinically indicated, according to the American College of Physicians 1
Use a trauma-informed approach with explicit permission if pelvic examination is indicated, as recommended by the National Institute of Mental Health 1

Do NOT skip bone density preventive health education even though testosterone therapy is planned, as stated by the National Osteoporosis Foundation 2
Testosterone therapy does not eliminate the need for bone health counseling, as individual responses vary and long-term monitoring may still be needed, according to the Endocrine Society 2

Obtain baseline testosterone levels, hematocrit/hemoglobin, and lipid panel before initiating testosterone therapy, as recommended by the American Association of Clinical Endocrinologists 2
Obtain liver function tests to establish baseline before hormone therapy, according to the American Gastroenterological Association 2
Consider baseline bone density assessment if risk factors present, as stated by the National Osteoporosis Foundation 1

Follow-up at 1-2 months for efficacy evaluation and dosage adjustment if needed, as recommended by the American Urological Association 2
Monitor every 3-6 months for the first year, then annually thereafter, according to the American College of Physicians 2
Check testosterone levels, hematocrit/hemoglobin regularly to monitor for polycythemia, a common side effect, as stated by the American Society of Hematology 2

Do not assume sexual inactivity or low STI risk based on gender identity alone, as stated by the Centers for Disease Control and Prevention 1
Do not perform unnecessary invasive examinations that may cause trauma or worsen gender dysphoria, according to the American Medical Association 1
Do not delay medically appropriate gender-affirming care by requiring multiple visits when one would suffice, as recommended by the World Professional Association for Transgender Health 1
Do not overlook routine preventive care (cancer screening, cardiovascular risk assessment) while focusing on gender-affirming treatment, according to the American College of Radiology 3

Transmasculine patients without chest surgery have breast cancer risk comparable to cisgender women regardless of testosterone therapy, as stated by the American College of Radiology 3
If age-appropriate (typically 40+), discuss mammography screening even if planning future chest surgery, according to the American Cancer Society 4
After chest surgery (mastectomy), breast cancer risk becomes very low but residual tissue should still be monitored clinically, as recommended by the American Society of Breast Surgeons 4