October is Breast Cancer Awareness Month, and screening isn’t one-size-fits-all. Learn how hormone therapy, gender-affirming surgery and family history can affect breast cancer risk for trans and gender-diverse people, and when to start talking with your provider about screening.
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Explore how self-discovery and online community validate transgender, gender-diverse, and autistic identities beyond clinical diagnosis.
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Feeling overwhelmed trying to find the right therapist? This guide breaks down common therapy approaches like CBT, DBT, ACT, EMDR, IFS, and Brainspotting to help you better understand your options and find the best fit for your mental health needs.
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Feeling overwhelmed trying to find the right therapist? This guide breaks down common therapy approaches like CBT, DBT, ACT, EMDR, IFS, and Brainspotting to help you better understand your options and find the best fit for your mental health needs.
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Feminizing top surgery, also known as breast augmentation, can be an important gender-affirming step for many trans women and transfeminine individuals. This guide explores implant options, HRT requirements, surgical techniques, risks, recovery considerations, and what to discuss with your surgeon when planning care.
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Gender Affirming Hormone Therapy (GAHT) is a treatment that helps people feel more at home in their bodies by aligning physical changes with their gender identity. It may include hormones like estrogen or testosterone, as well as medications that regulate natural hormone production.
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An evidence-based guide to fertility preservation for transgender and gender-diverse people, covering HRT, surgeries, options, and barriers to care.
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Cervical cancer is a common cancer for people assigned female at birth. An estimated 13,360 people AFAB were diagnosed with cervical cancer in the U.S. in 2025 (National Cancer Institute, 2025). There are also stark racial inequalities with cervical cancer. The death rate from this cancer is 65% higher for Black and Native American people AFAB than white people (American Cancer Society, 2025). Many people don’t know that the Human Papilloma Virus (HPV) causes most cases of cervical cancer, over 90% (CDC, 2025). However, there is a highly effective vaccine to prevent HPV and the cancers it causes.
When the vaccine was first released, we understood less about HPV and the kinds of cancer it could cause. The HPV vaccine was originally targeted to young cisgender girls and TGD people assigned female at birth, because of the strong connection between HPV and cervical cancer. This has led to the common misconception that there’s no benefit to vaccination for people assigned male at birth, including trans women and AMAB enbies. Since the HPV vaccine was released, we’ve learned that HPV is also one of the leading causes of anal, penile, and throat/ mouth cancers. Each year, about 16,000 people AMAB are diagnosed with an HPV related cancer (CDC, 2025).
HPV is the most common sexually transmitted infection (STI) in the world. There are many subtypes of HPV, some more likely to cause cancer than others. For example, HPV types 6 and 11 cause over 90% of genital warts, which rarely lead to cancer. HPV is spread through skin to skin contact with the genitals of a person with HPV. This means condoms only provide a little protection from HPV, as they don’t cover all skin in the genital area (American Cancer Society, 2025). Getting bottom surgery doesn’t “reset” the risk of getting HPV for TGD people. About 13 million Americans, including teens, get HPV each year (CDC, 2024). By age 50, 75% of people will have had HPV (Palesky and Cox, 2025). The body’s immune system usually fights off the virus, causing no long term consequences. However, some individuals immune systems may not clear the virus. when this happens, long term infection may go on to cause precancerous conditions and cancers, including cervical cancer.
Though more research is needed, it seems that TGD people are more likely to be impacted by HPV and the cancers it causes. TGD people are slightly less likely to get the HPV vaccine. One study has found that only 32.6% of trans women had received it, compared to 67.8% of cisgender girls and 58.3% of cisgender boys (Sabeena & Ravishankar, 2025). Transgender men also had 62% lower odds of HPV vaccination compared with cisgender women ( Pho et al., 2022). Numerous studies suggest that healthcare providers may be less likely to offer the HPV vaccine to LGBT patients (Meites at al., 2022). While this is likely due to heterosexist messaging when the vaccine was released, lack of healthcare provider knowledge is one the systemic causes of health inequity for LGBT people.
HIV positive people are also at heightened risk of HPV infection and the cancers associated with HPV. Because HIV weakens the immune system, it can cause HPV related cancers to develop more often and more quickly. The risk of anal cancer in HIV+ people is 40 times higher than the general population (Uuskula et al., 2025). The high risk of HIV in the trans community, particularly for trans women and trans femmes, means that HPV prevention is very important. So is routine anal cancer screenings starting at age 35 if you’re HIV+ or age 45 if you’re HIV negative.
The HPV Vaccine, under brand name Gardasil9 in the U.S., has been proven to prevent 9 strains of HPV and several cancers associated with HPV. Since the vaccine was approved in the U.S., cases of cervical cancer associated with HPV have dropped 40% (CDC,2024). Ideally, the vaccine is given to a child over 9 years old before they have sex for the first time. This reduces the chance they will develop diseases associated with HPV if they are exposed to it. The vaccine still works after someone has had sex, but each partner you have while unvaccinated could be a new exposure to HPV. The vaccine can’t cure HPV, only prevent someone from getting it. If you already have HPV when you get the vaccine, it can only reduce your risk of getting new types in the future. It also doesn’t offer as much protection from HPV related cancers.
The vaccine is delivered as a series of shots at your doctor’s office, pharmacy, or a reproductive health clinic, like Planned Parenthood. The number of shots needed depends on how old you are when you start the vaccine series.
Even if you can’t complete the full vaccine schedule, getting one shot of the HPV vaccine still helps protect you from HPV and cancer.
The HPV vaccine is not generally recommended for people over 26. Your doctor may suggest it depending on your personal medical history and risk factors. If you’re trying to get the HPV vaccine as an adult, it’s a good idea to call your doctor’s office in advance to make sure they have it. Because the vaccine is most effective when given in childhood, your doctor may not carry it if they don’t see kids. If your doctor doesn’t have it in stock, they may be able to order it, or refer you to a reproductive health clinic or pharmacy that has the vaccine. Insurance companies are required to cover the vaccine for people up to age 26. Some insurances may cover it for those up to age 45. Calling your insurance company and asking about coverage of Gardasil9 (CPT:90651) is the best way to ensure it’s affordable for you.
The HPV vaccine is also available for free through the Vaccines for Children (VFC) Program.
The Human Papilloma Virus (HPV) is a common sexually transmitted infection that can cause several types of cancer, including cervical, penile, head/neck and anal cancers. An effective vaccine is available to prevent HPV and the cancers it causes. The HPV vaccine is now recommended for all people under 26 years of age, regardless of gender identity or sex assigned at birth. If you’re over 26, your doctor may still recommend it based on your personal medical history. The HPV vaccine is particularly important for TGD people, because they may be more likely to have high risk strains of HPV and less likely to get cancer screening tests on the recommended schedule. Getting the HPV vaccine not only protects you from cancer, but also prevents spreading HPV to your sexual partners and protects your loved ones.
Places to get the HPV vaccine in the Charlotte Area:
December 1st is World AIDS day! Since 1988, this observance has raised awareness about AIDS and the virus (HIV) that causes it while also creating space to memorialize loved ones who have died from AIDS-related illnesses. While great advancements have been made to prevent and treat HIV over the last 37 years, there is still a long way to go and a number of inequalities in HIV related care; an estimated 1.2 Million people in the US have HIV, 40% of whom are Black (KFF, 2024). HIV is also more likely to affect trans and gender diverse (TGD) people than cisgender people. Worldwide, the odds of a transgender woman getting HIV is 66 times higher than the general population (Stutterheim et al., 2021).
However, HIV research and advocacy has historically sidelined people AFAB and excluded trans men from research. A 2021 meta-analysis, shows that 96 studies (n=48,604) looked at HIV risk among trans women, compared to just 20 studies (n=6,460) that included trans men. While more inclusive research is needed, scientists currently estimate the odds of a trans masculine person getting HIV are almost 7 times higher than the general population (Stutterheim et al., 2021). Some medications used to prevent HIV are not technically approved for people AFAB because their manufacturers haven’t proven they are as effective at preventing HIV through vaginal sex as anal sex. Despite these barriers and gaps in knowledge, understanding their risks and prevention options is important for all trans men and nonbinary people who were AFAB.
The Human Immunodeficiency Virus (HIV) is an infection that attacks the body’s immune system. HIV is spread through contact with an infected person’s bodily fluids, including blood, semen (cum), vaginal fluids, and breast milk. Most cases are related to sexual contact or sharing injection materials with a person who has HIV. While there is currently no cure for HIV, there are several medications to prevent and manage it.
Two to four weeks after they get the virus, some people may have symptoms like a fever or chills, swollen lymph nodes, muscle aches, and tiredness. Among people assigned female at birth, including trans men and transmasculine people, symptoms also include severe vaginal yeast infections that keep coming back, and changes to the menstrual cycle (heavier periods OR missed periods) (AIDS Healthcare Foundation, n.d.). However, some people never have symptoms. The only way to know for sure if you have HIV is to get tested.
Acquired Immunodeficiency Syndrome (AIDS) is the most severe stage of HIV infection. Without treatment, HIV breaks down the immune system and leads to AIDS around 8-10 years after infection. People with compromised immune systems may have a hard time getting over common, minor illnesses, like a cold. Illnesses that are caused by a weakened immune system are called opportunistic infections. Opportunistic infections are one of the biggest health risks to people with AIDS. While not the case in the US, the leading cause of death for HIV+ people globally is tuberculosis (TB) which claimed the lives of over 161,000 HIV+ people in 2023 (WHO, 2024).
Most people with HIV never have symptoms. This means routine testing is critical for protecting your health and the health of your partners. Men who have sex with men, including gay and bisexual trans men, should get tested every 3-6 months. Other sexually active adults may be able to get tested as infrequently as once a year. Regardless of gender identity, sex assigned at birth, or sexual orientation, talking to your doctor about your unique risk factors and behavior is the best way to figure out a testing schedule and prevention methods for you.
Most HIV screening tests use a mouth swab or finger prick to look for signs of HIV in your blood or saliva. You can often get results in as few as 20 minutes. If this test is positive, or shows signs of HIV infection, your doctor will order more tests and draw blood from a vein to confirm the results before diagnosing you with HIV (Cleveland Clinic, 2022). If you test positive for HIV, starting treatment is important for your health and to prevent spreading it to other people.
Because HIV is usually spread through sexual contact, using condoms every time you have sex is one of the easiest ways to prevent it. Internal condoms and traditional external condoms are both effective at preventing HIV and other STI’s, as long as they’re used correctly. There is also a high risk of getting HIV if you use drugs through injection. If you’re at risk from injection drug use, it’s important not to share or reuse injection materials (works) like needles, syringes, cookers, or filters. Make sure to dispose of any used needles in a secure, puncture proof sharps container.
Pre-Exposure Prophylaxis (PrEP) is a group of medications people without HIV can take to prevent getting it. The medication works by stopping the virus from copying itself and growing. If you take PrEP and are exposed to the virus, you are much less likely to get it; PrEP reduces the risk of getting HIV from sex by 99% and from injection drug use by at least 47% (National Institutes of Health, 2025). PrEP is currently available as a pill you take everyday or a shot you get at the doctors office every 2 months. There are several brands of PrEP, but it’s important to discuss your sexual behavior and which medications are most effective for preventing HIV spread through vaginal or anal sex with your doctor. Your doctor will talk through the risks and benefits of each medication and help you decide what’s best for you.
Post-exposure Prophylaxis (PEP) is another medication that can be used to prevent HIV in emergency situations. For example if someone is sexually assaulted or accidentally stuck with a used needle, PEP can reduce the risk of getting HIV by more than 80% (National Institutes of Health, 2025). However, PEP needs to be started within 72 hours (3 days) of the potential exposure to HIV to work. The sooner you take it, the more likely PEP is to prevent HIV. PEP isn’t supposed to be used often; if someone is frequently exposed to HIV, PrEP might be a better fit for their needs.
Neither PrEP or PEP are known to interact with HRT. Taking either medication won’t make your hormones work worse or more slowly. HRT also doesn’t make PrEP less effective at preventing HIV. While taking testosterone, some trans masculine people may experience vaginal dryness or atrophy (when the vaginal canal gets smaller). Vaginal atrophy can make it more likely to get small cuts or tears inside the vaginal canal during sex. These tears can give HIV direct access to your bloodstream, making the risk of getting HIV higher. This is one of the reasons PrEP and other prevention methods are important for trans masculine people. If you have pain or bleeding during sex or have a hard time getting or staying wet, using lube can help. Your doctor may also have other suggestions if you discuss it with them.
While HIV can seem like a dark cloud over the trans community, there are things we can do to protect ourselves and our loved ones. Particularly for trans people assigned female at birth, including trans men and nonbinary people, more research, education, and support is needed to address inequities in the response to HIV. Routine HIV testing is the only way to know if you have it. Using condoms is vital. PrEP and PEP are powerful HIV prevention medications used in different situations. The resources below include several Charlotte area organizations working to free our community from HIV.
AIDS Healthcare Foundation. (n.d.). What is HIV? HIV Care. Retrieved November 19, 2025, from https://hivcare.org/hiv-basics/
KFF. (2024, August 16). The HIV/AIDS Epidemic in the United States: The Basics. KFF. https://www.kff.org/hiv-aids/the-hiv-aids-epidemic-in-the-united-states-the-basics/
National Institutes of Health. (2025, March 31). Post-Exposure Prophylaxis (PEP) | NIH. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/post-exposure-prophylaxis-pep
Stutterheim, S. E., Dijk, M. van, Wang, H., & Jonas, K. J. (2021). The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis. PLOS ONE, 16(12), e0260063. https://doi.org/10.1371/journal.pone.0260063
World Health Organization. (n.d.). Global tuberculosis report 2024. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024
This is the time when you can renew or change your health insurance for the upcoming year through the Affordable Care Act (ACA) Marketplace. While insurance is always complicated, 2026 will bring new challenges for TGD and low income people.
Federal policies and budgets play a large role in regulating services through Medicare, Medicaid, and Tricare/ Veterans Health Administration. In response, private insurance companies often mirror federal policies, even when they’re not legally obligated to do so. Particularly as the North Carolina state government and the federal government have failed to pass a budget for fiscal year 2026, these factors add up to a confusing, constantly changing landscape of coverage for TGD people.
Passed into law in 2010 by the Obama Administration, the Affordable Care Act (ACA), also known as Obamacare, is a healthcare reform law that created a new pathway to insurance coverage for people who don’t get health insurance through their employer. Since it began offering insurance plans in 2014 it has provided health insurance to over 49.4 million unique individuals (U.S. Department of Treasury, 2024). Over 1 million North Carolinians were covered through ACA plans in 2024 (KFF, 2025).
These plans are partially funded by the federal government, through premium tax credits; people with an ACA plan can deduct a portion of their monthly insurance premiums from their income taxes each year. In 2021 as part of COVID response policies, the federal government enhanced these tax credits making insurance affordable for more people. These enhanced premium tax credits are one of the key issues at the core of our current government shutdown as they are set to expire, returning the deduction to its pre-pandemic rate. This proposed subsidy cut coincides with a 28% increase for North Carolinians with ACA plans (NC Department of Insurance, 2025). Monthly premiums for ACA plans are expected to skyrocket, particularly for people near the federal poverty level ($15,650 for a single adult in 2025). An estimated 4.8 Million people will lose their insurance coverage in the coming year (Urban Institute, 2025).
You can browse ACA plans on Healthcare.gov at any time between November 1st and January 15th. In North Carolina, you must sign up for an insurance plan by December 15th (12/15/2025) for coverage to start on January 1st, 2026 (01/01/2026). If you need an ACA plan and don’t sign up for one at this time, you won’t be able to enroll unless you have a qualifying life event, like aging out of your parents insurance (at 26 years old), having a baby, or becoming a US citizen.
Medicaid is a type of insurance regulated jointly by the federal and state government which supports low income people and people with disabilities. It covers primary care, emergency room visits, and prescription medication, as well as vision and some dental care with no monthly fees and copayments capped at $4. Medicaid is our nation’s largest public healthcare program in terms of annual spending at over $918 Billion in 2024 (KFF, 2025).
In 2024, North Carolina expanded eligibility for Medicaid and enrolled over 600,000 people. Our state legislators have failed to pass a budget that meets the needs of the program, carrying over the budget from last year and by reducing the reimbursements paid to healthcare providers. This is particularly concerning as the “One Big Beautiful Bill Act” (HR1), passed in July of 2025, will reduce nationwide Medicaid spending $900 billion ($23B in cuts in NC), resulting in over 10 million additional Americans without insurance by 2035 (Euhus et al., 2025). North Carolina state legislators will be responsible for finding funding to continue Medicaid at its current scale.
Visit the NC DHHS Website for more information about Medicaid eligibility and enrollment.
If you need help selecting an ACA plan for 2026, or applying to Medicaid CTH will be hosting an enrollment event on December 11th, 2025 from 3-7PM. Subscribe to our Monthly Newsletter or follow us on social media for more details soon!
You can also contact your representatives to demand the that enhanced premium tax credits remain in the new federal budget.
