Screenings for transgender and nonbinary people

How the guidelines handle sex and gender

Breast cancer (USPSTF, 2024). Applies to cisgender women and all other persons assigned female at birth, including transgender men and nonbinary persons, 40 or older at average risk. The USPSTF says the benefit estimates are driven by sex rather than gender identity. (USPSTF, 2024)
Cervical cancer. The USPSTF recommendations apply to individuals who have a cervix. (USPSTF, 2018 cervical) ACS says women and other individuals with a cervix should follow its guideline. (ACS, 2025)
Osteoporosis (USPSTF, 2025). Written as "men" and "women", but the benefit estimates are driven by sex assigned at birth rather than gender identity. Transgender men and women who have not had any hormonal treatment likely have the same risks as people of their sex assigned at birth, and the USPSTF says they should talk with their clinician about which recommendation best applies to them. (USPSTF, 2025)
Abdominal aortic aneurysm (USPSTF, 2019). Written as "men" and "women", with the benefit estimates driven by biologic sex rather than gender identity. (USPSTF, 2019)

Organ by organ

Cervix

The USPSTF recommends cervical screening every 3 years with cytology alone from 21 to 29, and recommends against screening after a hysterectomy with removal of the cervix for people with no history of a high-grade precancerous lesion or cervical cancer. (USPSTF, 2018 cervical)
UCSF says cervical screening for transgender men, including the interval and the ages to start and stop, follows the recommendations for non-transgender women. It also notes that Pap tests in transgender men are more often unsatisfactory than in non-transgender women. (UCSF, cervical)
NHS England says trans women and non-binary people assigned male at birth do not need cervical screening, as they do not have a cervix. (NHS England, 2026)

Ages and tests: cervical cancer screening and Pap smear: what to expect.

Breast tissue

Assigned female at birth. The USPSTF recommends a screening mammogram every 2 years from 40 to 74. (USPSTF, 2024) UCSF says transgender men who have not had a bilateral mastectomy, or who have had only a breast reduction, should be screened as for non-transgender women, and that no reliable evidence exists to guide screening after a mastectomy. (UCSF, breast (men))
Transgender women. UCSF recommends screening mammograms every 2 years from age 50, once a person has used feminizing hormones for at least 5 years (some clinicians wait up to 10), and rates this a weak recommendation. (UCSF, breast (women)) In England, trans women registered with a GP as female are invited from 50 up to their 71st birthday; those registered as male are not invited, but a GP can refer them for mammograms. (NHS England, 2026)

More: breast cancer screening and mammogram: what to expect.

Prostate

The USPSTF says that for men 55 to 69, the decision to have periodic PSA screening should be an individual one. (USPSTF, 2018 prostate) UCSF says clinicians should remain aware of the possibility of prostate cancer in transgender women, even after removal of the testes, and that the decision to screen should be based on the guidelines for non-transgender men. (UCSF, prostate) More: prostate cancer screening and PSA test results.

Bone density

The USPSTF recommends osteoporosis screening for women 65 or older, and for postmenopausal women under 65 at increased risk of fracture. (USPSTF, 2025) UCSF says there is not enough evidence to guide bone density testing in transgender people, and suggests starting at 65 regardless of sex assigned at birth, considering testing from 50 to 64 for people with established risk factors, and considering it at any age after removal of the gonads with at least 5 years without hormone replacement (a weak recommendation). (UCSF, bone) More: osteoporosis screening and how often to have a bone density test.

Aorta

The USPSTF recommends a one-time ultrasound for abdominal aortic aneurysm in men 65 to 75 who have ever smoked. (USPSTF, 2019) NHS England invites people registered as male at 65, and says any trans woman or non-binary person assigned male at birth has the same risk as a man and should consider screening, even if registered as female. (NHS England, 2026) More: AAA screening.

Screenings that do not depend on sex

In England, both men and women are invited for bowel cancer screening every 2 years from 50 to 74. (NHS England, 2026) Other age-based screenings are listed on screenings by age and gender, including colorectal cancer and anal cancer screening.

Why records or insurance can block a due test

Invitations follow the registered sex. In England, breast and cervical invitations go to people registered with a GP as female, and AAA invitations to people registered as male. Trans men and non-binary people registered as male who still have a cervix can opt in to cervical invitations through their GP, practice nurse, sexual health clinic or transgender health clinic. NHS England says it is important that your GP keeps your records up to date so you are invited correctly. (NHS England, 2026)
Claims can be denied for a "sex mismatch". UCSF describes automated systems that deny a claim when the sex in the electronic record does not match a test covered only for the other sex, and billing codes that override such a mismatch (condition code 45 and the KX modifier, which Medicare contractors are required to process). This page was written in 2016. (UCSF, insurance)

Where guidance is limited

UCSF grades its recommendations by the data behind them. Its general organ-based rule, its cervical screening advice and its bone density advice are based on expert opinion with no data in transgender people; its breast screening advice for transgender women rests on some observational data and is rated weak. (UCSF, grading)(UCSF, 2016)(UCSF, cervical)(UCSF, bone)(UCSF, breast (women))
The UCSF guidelines were published in 2016, and the site says a revision is forthcoming in 2026. (UCSF, 2016)
The USPSTF notes there are no cervical screening data for people who identify as transgender, and lists more research on bone density in transgender persons as a research need. (USPSTF, 2018 cervical)(USPSTF, 2025)

When to talk to a doctor

The NHS England guide for trans and non-binary people says: (NHS England, 2026)

Breast: keep aware of the symptoms of breast cancer, and contact your GP if you notice any unusual changes.
Cervix: if you have symptoms such as unusual vaginal discharge or bleeding, or pain during or after sex, speak to your doctor even if you have had a normal cervical screening result.
Bowel: 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.

Where they differ:

Breast risk in transgender women. UCSF says the data so far suggest risk is not higher, and possibly lower, than in non-transgender women. (UCSF, breast (women)) NHS England says long-term hormone therapy can increase the risk of breast cancer. (NHS England, 2026)
Breast screening start and interval. The USPSTF starts at 40, every 2 years, for people assigned female at birth. (USPSTF, 2024) UCSF starts transgender women at 50, every 2 years. (UCSF, breast (women)) The NHS invites from 50 up to the 71st birthday, every 3 years. (NHS England, 2026)
Cervical screening start. The USPSTF starts at 21. (USPSTF, 2018 cervical) ACS starts at 25 and continues until at least 65. (ACS, 2025) The NHS invites from 25 to 64. (NHS England, 2026)
Who is screened for AAA. The USPSTF bases its advice on biologic sex. (USPSTF, 2019) The NHS invites by registered sex, and says trans women should consider screening even if they are not invited. (NHS England, 2026)

Your doctor decides what your result means for you.

Questions people ask

Which screenings apply to me?

UCSF guidelines say that if a person has a particular body part or organ and otherwise meets the criteria for screening, screening should go ahead. A full medical and surgical history is how your clinician works out which screenings you need. (UCSF, 2016)

Do transgender men and nonbinary people with a cervix need cervical screening?

The USPSTF and ACS cervical screening recommendations apply to people who have a cervix. UCSF says screening for transgender men follows the same ages and intervals as for non-transgender women. (USPSTF, 2018 cervical) (ACS, 2025) (UCSF, cervical)

Does the USPSTF breast cancer recommendation include transgender men?

Yes. The 2024 USPSTF breast cancer recommendation applies to cisgender women and all other persons assigned female at birth, including transgender men and nonbinary persons, aged 40 or older at average risk. (USPSTF, 2024)

Do transgender women need prostate screening?

UCSF says clinicians should remain aware of the possibility of prostate cancer in transgender women, and that the decision to screen should be based on the guidelines for non-transgender men. (UCSF, prostate)

Why was I not invited for a screening I am due for?

In England, NHS invitations depend on the sex registered with your GP, so some people are not invited automatically and need a referral or to opt in. UCSF notes that in the United States some billing systems deny claims when the sex in the record does not match the test. (NHS England, 2026) (UCSF, insurance)