Gender affirming care has been endlessly vilified by the right, but for one trans woman, it was exactly this kind of care that saved her life — twice.
Not only does access to this kind of care preserve the mental health of trans, nonbinary, and gender diverse patients, but having access to preventive care that validates your identity can also catch life-threatening diseases.
This is exactly what happened to Jennifer Trefzger, whose cancer diagnosis was initially missed because of the stigma around gay sex, and then later caught because she sought out gender affirming care.
“It's kind of scary,” Trefzger tells PRIDE. “Had I not transitioned, who knows when I would have been diagnosed. It was already stage 4. The symptoms started before my transition. So I can't imagine what would have happened if I didn't transition. Well, I can, I'd likely be dead.”
Before transitioning, when she was just a teenager, Trefzger sought out medical care because she was struggling with rectal bleeding. The 16-year-old autistic, queer teen had never had sex, but her symptoms were ignored because the doctor assumed anal sex was responsible for the bleeding. Being asked intrusive questions about anal sex at such a young age was traumatizing for Trefzger who then spent years ignoring her increasingly worrying symptoms.
“That experience made me dismiss my symptoms and never talk about it again,” she says. “I don't even know how often I was bleeding. I just stopped checking.”
Trefzger already had colon cancer at this time — she just didn’t know it yet. It wouldn’t be until she was 23 that her cancer would finally be caught because of routine bloodwork done as part of her gender affirming care.
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She started Hormone Replacement Therapy (HRT) when she was 19, and in 2017, her endocrinologist discovered that she had abnormally low iron levels, and her red blood cell morphology was also low. This prompted her doctor to order a colonoscopy, which found a tumor blocking her descending colon. Unfortunately, because it was ignored for so many years, the cancer had advanced to stage 4 before she was diagnosed.
She was told that she had a 15% chance of surviving, and had to undergo a colectomy, which removed part of her colon and 25 lymph nodes, before undergoing 12 rounds of chemotherapy. Despite the low odds of making it, the surgery and chemo worked, and she was told she was cancer free.
But when Trefzger went under the knife for facial feminization surgery, she had a stroke that caused blindness in her left eye. This was a tragic outcome, but the scans done in the wake of her stroke found cancerous nodules in her lungs because her colon cancer had metastasized.
After more surgeries, chemo, and hospitalizations, she successfully beat cancer. Trefzger is now 31 years old and has been cancer free for over four years, in large part because of the work of her gender affirming care doctors.
“I've talked to people who have had cancer found because of gender affirming care,” she says. “We’re a marginalized community. Intentionally or not, doctors will dismiss us. Just like other marginalized communities. People will die. Whether it's cancer, autoimmune, or other serious conditions.”
Trefzger hopes her story will inspire others to seek out treatment and advocate for themselves. “My gender-affirming care was instrumental in saving my life,” she says. “My story shows that it is possible to survive medical trauma and continue to become your true self. My advice for others is to advocate for yourself, get a second opinion from an NCI-designated center, join Colontown, see a dietitian, and do physical therapy."
Can routine gender affirming care help detect illnesses?
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Access to routine and preventive healthcare is important for early detection of preventable diseases, including cancer. But the LGBTQ+ community, and especially trans people, often avoid seeking out medical care because of the stigma they face or lack access because the type of care they are looking for — such as gender affirming care — isn’t always available, especially in Republican strongholds where politicians and conservative Christians are trying to ban it.
“We know that transgender and gender diverse patients often avoid routine primary and preventive care due to prior discrimination or dismissal,” Dr. Anne Marie O’Melia, a pediatrician, child and adolescent psychiatrist, and eating disorder specialist, tells PRIDE. “When they finally have a clinician who respects their name, pronouns, and body, they are much more likely to disclose all symptoms of concern.”
A 2024 survey done by the Kaiser Family Foundation found that queer people are twice as likely as non-LGBTQ+ adults to report negative experiences while receiving health care, and are more likely than their non-LGBTQ+ counterparts to report adverse consequences due to negative experiences with health care providers.
“Routine gender affirming care does more than adjust hormone levels,” Dr. O’Melia says. “It creates a consistent, trusting relationship with the health system, and that is often what allows other medical and psychiatric conditions to be recognized early.”
Bloodwork done during the normal course of gender affirming care can catch things like the low iron levels that indicated to Trefzger’s doctor that there might be a bigger problem. It can also detect issues like blood disorders, diabetes, hyperlipidemia, hypertension, thyroid disease, and vitamin D deficiency. If you have a doctor whom you trust and feel comfortable with, you’re also more likely to report new symptoms.
If you think you may have colon cancer, what tests or screenings should you ask your doctor for?
If you’re having symptoms, like rectal bleeding, persistent changes in bowel habits, ongoing abdominal discomfort, unexplained weight loss, or frequently feel fatigued, then it’s time to talk to a doctor about testing for colon cancer.
According to Dr. Wanping Hu, an oncologist with the Southern California Permanente Medical Group, if you are having symptoms, you’re doctor should do a battery of bloodwork, including a CBC panel, a comprehensive metabolic panel, and an iron panel, along with a colonoscopy — which she calls “the gold-standard test for evaluating the colon” — as well as a CT scan and other stool-based tests.
“Colon cancer is increasingly diagnosed in younger adults, and routine screening guidelines may not catch early cases,” Dr. Hu says. “If you have symptoms like persistent constipation, unexplained fatigue, rectal bleeding, or iron deficiency anemia, be persistent. Ask questions, request evaluations, and follow up if symptoms continue.”
Is it important to advocate for yourself with your doctors?
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Talking to your doctor about health issues — even ones that might be embarrassing to disclose — is important if you want to catch diseases like colon cancer when they are still treatable.
“Self advocacy matters, especially for LGBTQ+ patients who have been minimized or mistreated, but it should never be the only protection a person has,” Dr. O’Melia says. “Trauma informed, gender affirming care means that the responsibility for safety rests primarily with the clinician and the health system, not with the patient who has already experienced harm.”
This kind of routine healthcare from a gender and sexuality affirming provider can not only detect major health issues like cancer, but can also catch eating disorders, substance abuse, and other mental health conditions. But Dr. O’Melia says that it’s important for doctors to take on the responsibility of asking questions and showing their patients that they are open-minded enough to listen to their concerns.
“From the clinician side, I would emphasize that it is our job to lower the threshold for disclosure,” she says. “That means routinely asking all patients about disordered eating, substance use, and trauma history, not only when they fit a stereotype, and explicitly naming that eating disorders are common and treatable in LGBTQ+ communities.”
If you have symptoms but feel embarrassed to talk about the possibility of colon cancer, what should you do?
If you’re feeling too embarrassed to talk to your doctor about anal bleeding, the consistency of your stool, or any sexual health issues, think about practicing the conversation with a trusted friend first and try to remember that doctors are used to having frank conversations about body parts and bodily functions.
“Don’t let embarrassment delay care, early detection saves lives,” Dr. Hu says. “Talk with your primary care doctor and request a referral to a gastroenterologist for a colonoscopy. If you prefer a less invasive option, you can ask for a CT colonography, which uses CT imaging to create 2D and 3D views of the colon to detect polyps or cancer.”
What is the best way to find an LGBTQ+ friendly oncologist?
Dr. O’Melia recommends looking for an LGBTQ+ friendly oncologist through GLMA: Health Professionals Advancing LGBTQ+ Equality, the World Professional Association for Transgender Health (WPATH), or with your local LGBTQ+ health education center. If you have a trusted physician or gender-affirming care doctor, you can also ask for a referral.
Once you find a doctor you think might be a good fit, be on the lookout for signs that the clinic or doctor’s office will be accepting. “Practices that collect name and pronouns separately from legal sex, provide gender neutral restrooms, and explicitly mention LGBTQ+ people in their materials are more likely to be prepared to care for transgender and nonbinary patients,” she says.
When you meet with the doctor for the first time, don’t be shy about asking questions, or consider asking for a “screening call” before scheduling a full appointment. You can ask if they have any transgender or nonbinary patients, how they handle names and pronouns, and if they’re comfortable talking about gender affirming care. “If the answers are respectful, specific, and welcoming, that is a good sign,” she says. "If the answers are defensive, vague, or dismissive, that is useful information too.”
Sources cited:
Dr. Anne Marie O’Melia, a pediatrician, child and adolescent psychiatrist, and eating disorder specialist.
Dr. Wanping Hu, an oncologist with the Southern California Permanente Medical Group.
