Cancer does not erase who you are.
Your gender, your body, your partners, and your history still matter during every step of diagnosis and treatment.
Research from many countries shows something hard and honest. LGBTQ people with cancer meet more barriers than straight and cisgender patients when tests start, when the doctor gives the news, and when treatment begins. These barriers include stigma, bad communication, lack of respect for gender identity, and fights over gender affirming care. [1][2][3][7][10][21] Wiley Online Library+5PubMed+5PubMed+5
This essay explains what those barriers look like, how they affect your health, and what support you deserve.
What diagnosis means in cancer care
Diagnosis means finding out if you have cancer, what kind, and how far it has spread.
That process usually includes
Tests and scans
Biopsies
Visits with specialists
A clear talk about the results and next steps
For LGBTQ people, research shows extra hurdles along this path. Many oncology teams do not know a patient’s sexual orientation or gender identity at the time of diagnosis. [3][19] PubMed+1
That gap shapes everything that follows.
Barriers at the moment of diagnosis
First barrier. Your identity is invisible in the chart.
Cancer centers often fail to record sexual orientation and gender identity in a routine and respectful way. A colorectal cancer advocacy group reports that many oncology teams still do not know who their LGBTQ patients are, even after diagnosis. [19] Fight CRC
Without this basic information, staff fall back on guesswork. They use names and pronouns from old records. They assume straight and cisgender lives. You end up carrying the weight of correcting everyone or staying silent.
Second barrier. Heteronormative and cisnormative assumptions.
Systematic reviews of lesbian, gay, and bisexual people with cancer show repeated examples of providers who assume every patient is straight and cisgender. [2][6][18] PubMed+2Wiley Online Library+2
Common patterns include
Asking only about “husband” or “wife”
Ignoring same sex partners in the room
Treating friends as less important than legal family
Assuming everyone has the same body parts
Studies of LGBTQ cancer patients describe how these habits turn a hard day into a painful one. People talk about feeling erased at the exact moment when they need clear support. [1][2][6] PubMed+2PubMed+2
Third barrier. Discrimination and disrespect.
A global review of LGBTQ cancer care found that stigma and discrimination in health systems lead to late diagnoses, distrust, and higher distress. [3][10][21] PubMed+2Wiley Online Library+2
These experiences do not start at cancer. Many LGBTQ people bring long histories of bad care, starting in childhood. That history shapes every new visit.
Fourth barrier. Extra fear for transgender and gender diverse people.
Trans and nonbinary patients face a tight knot of stress during diagnosis. Reviews of cancer care for transgender people report common problems. Staff use wrong names. Records show wrong gender. Clinicians show confusion about which organs you have. Some blame gender identity for health problems. [11][12] ACS Publications+3PubMed Central+3ASCOPubs+3
Trans people diagnosed with cancer, in several studies, describe feeling on guard during every scan, exam, and conversation. Many worry that sharing information about hormones or surgeries will change the way teams treat them as people. [5][8] PubMed+2ScienceDirect+2
Policy fights also add pressure. In some regions, hospitals restrict gender affirming care because of politics or religious rules. Court cases and government orders around gender affirming care appear often in the news. [20] TIME+5AP News+5Axios+5
For many trans people, this climate turns any hospital visit into a risk.
Barriers during treatment decisions
After diagnosis, treatment planning begins. This step should match your cancer type, stage, other health issues, and your values and goals. For LGBTQ patients, research describes several extra barriers during this stage.
Limited trust and poor communication
Large reviews report that sexual and gender minority patients often feel less satisfied with communication during treatment than other patients. [1][5]
People describe
Doctors who avoid talk about sex, touch, and relationships
Nurses who leave partners out of key conversations
Staff who rush through questions about mental health or safety
Pressure to “fit” gender expectations during surgery
Surgery brings its own set of barriers. A report for oncology teams describes cases where chest or pelvic surgery served both as cancer treatment and as gender affirming care for some genderqueer and trans patients. For others, pressure for “feminine” reconstruction felt wrong. [14] /
Examples from research include
Butch lesbians pushed toward breast reconstruction they did not want
Nonbinary people whose flat chests after mastectomy matched their gender, yet staff framed the result as a loss
Trans men whose hysterectomy for cancer lined up with their transition goals, yet teams ignored that value
When teams assume one ideal body shape for all women or all men, they miss chances to support gender joy and self respect.
Side effects that ignore LGBTQ lives
Reviews of LGBTQ cancer care report a large gap in sexuality and body image support during treatment. [1][2][23] PubMed+2PubMed+2
Prostate cancer teams often focus on vaginal sex and erections only in “male-female” terms. Gay and bisexual men describe not receiving clear information about anal sex, receptive roles, or fear of pain and bleeding after treatment. [2][6] PubMed+1
Lesbian and bisexual women report that teams rarely talk about sex between women, changes in desire, or body image in same sex relationships. [2][13][20] PubMed+2Taylor & Francis Online+2
Trans people describe providers with little knowledge about how hormones, binding, tucking, or past surgeries interact with radiation fields, chemotherapy, or hormonal drugs. [11][12][13] Dana-Farber Cancer Institute+5PubMed Central+5ACS Publications+5
When side effect talks ignore real lives, treatment feels less safe and less honest.
Barriers linked to gender affirming hormones
Gender affirming hormone therapy, often called GAHT, supports many trans and nonbinary people. Estrogen, testosterone, and puberty blockers help align the body with gender identity.
New reviews show that GAHT changes cancer risk and treatment choices in complex ways. [13][12] ScienceDirect+2ACS Publications+2
Key points from current research
Data on GAHT and cancer are still limited
Hormones influence breast, prostate, and some gynecologic cancers
Stopping hormones without a plan harms mental health and quality of life
Experts in trans health and oncology stress that decisions about GAHT during cancer treatment need shared decision making. That means honest talks about risk, mental health, and values, not quick orders from clinicians who fear hormones in every case. [11][12][13][20] JAMA Network+6PubMed Central+6ASCOPubs+6
Yet trans patients in qualitative studies report that oncology teams sometimes demand a full stop on hormones at diagnosis, with little evidence and little support. [11][12][18] Memorial Sloan Kettering Cancer Center+3ASCOPubs+3ACS Publications+3
This pattern adds a harsh choice. Fight cancer while feeling pushed away from your gender. Or protect mental health and risk conflict with your care team.
Barriers linked to gender affirming surgery
Gender affirming surgeries, such as chest surgery, hysterectomy, oophorectomy, orchiectomy, and genital surgery, interact with cancer risk, diagnosis, and treatment. Radiation oncologists and surgeons describe these procedures as complex and personal. [14] Red Journal
Barriers in research and care include
Few clinical trials that include trans people by name
Limited guidance on imaging and biopsy in tissue that has been reshaped
Confusion over which screening tests remain needed after surgery
One cancer care guide for sexual and gender minority patients explains that for some genderqueer people, cancer surgery aligns with gender goals. For others, cancer treatment might undo gender affirming surgery in ways that feel devastating. [14][11][12] ASCOPubs+4/+4PubMed Central+4
Trans people also report problems in the hospital after surgery. Staff might use old names, assign beds on the wrong gender ward, or question the “realness” of their gender. [8][11][17][18] Memorial Sloan Kettering Cancer Center+3ScienceDirect+3PubMed+3
These actions slow healing and deepen trauma.
Barriers in clinical trials and advanced treatment
New cancer drugs and approaches often reach patients first through clinical trials. LGBTQ people are underrepresented in those studies.
An abstract on LGBTQ+ clinical trial barriers reports that many LGBTQ patients feel pushed out of trials by discrimination, distrust, and lack of clear information. They describe extra effort during consent processes, worries about disclosure, and fear that side effects will be worse due to hormones or HIV status. [16][10] ASCOPubs+1
When LGBTQ people have less access to trials, they receive fewer chances at cutting edge treatment. Evidence on treatment safety and dosing in trans and nonbinary bodies also stays thin, which hurts future patients.
Intersectional barriers
Not all LGBTQ people face the same conditions. Studies of Black and White sexual and gender minority patients show that racism and poverty add more weight. Black LGBTQ cancer patients report more mistrust, more negative encounters, and more gaps in pain control. [15][6][11] Taylor & Francis Online+4PubMed+4Liebert Publishing+4
Other work highlights problems for LGBTQ people in Asia, Latin America, and other regions, where legal protections differ and family pressure often feels intense. [5][8][10] Wiley Online Library+4ScienceDirect+4PubMed+4
Cancer care must take these layers into account. One-size answers do not work.
Good cancer care for trans and gender diverse people includes gender affirming care. [11][12][17][18] Memorial Sloan Kettering Cancer Center+4ASCOPubs+4ACS Publications+4
A JCO article on this topic offers simple starting points.
Ask every patient what name and pronouns they use.
Ask what parts of their body feel important for gender expression.
Ask how hormones, clothing, hair, or surgeries relate to their sense of self. [11] PubMed Central+1
The CA Cancer Journal for Clinicians review on trans cancer care adds more. Treatment teams need to know each patient’s anatomy, hormone history, and goals for the future. Plans for surgery, radiation, and systemic therapy should respect both survival and gender health. [12][13][14] ACS Publications+2ScienceDirect+2
Guidelines from UCSF, the Endocrine Society, and the World Professional Association for Transgender Health stress that safe hormone regimens and access to needed surgeries support overall health and reduce suicide risk. [13][20] ScienceDirect+3Transcare UCSF+3Endocrine Society+3
When oncology teams treat gender affirming care as optional or “extra,” they miss the full picture of health.
What helps during diagnosis and treatment
You did not create these barriers. Systems did. Responsibility for change rests with clinics, hospitals, and governments. Still, research suggests steps that help you protect yourself while that larger work moves forward.
Prepare for visits
Studies of LGBTQ cancer patients show better experiences when patients enter visits with clear goals and support. [3][7][18] /+3PubMed+3PubMed Central+3
You are able to
Write down your name, pronouns, and how you describe your identity
List your hormones, past surgeries, and current partners
Note your biggest fears and questions for this visit
Bring someone you trust
Ask direct questions about gender affirming care
You are able to ask
“How will this treatment interact with my hormones”
“What do you know about cancer care for trans or nonbinary patients”
“Who in this hospital has special training on LGBTQ health”
If the answers feel weak, you are able to request a second opinion or a different provider when that option exists. National psychology and behavioral medicine groups encourage LGBTQ patients to seek affirming providers and to use patient advocate offices inside hospitals when treatment feels biased. [27] Society of Behavioral Medicine (SBM)
Look for trans and LGBTQ-focused programs
Some cancer centers now run LGBTQ or trans-focused programs that aim to reduce these barriers. Examples include LGBTQI cancer care clinics, advisory councils with patient members, and staff training on pronouns, hormones, and chosen family. [17][18][21] /+2Memorial Sloan Kettering Cancer Center+2
Patients who receive care in these settings often report higher trust and better communication. [5]
Why this matters for justice
Barriers during diagnosis and treatment are not random. They come from laws, policies, and habits that treat some lives as standard and others as extra work.
Research on sexual and gender minority cancer patients link these barriers to worse mental health, higher pain, and lower quality of life long after treatment ends. [5][10][21][25] PubMed Central+3PubMed+3Wiley Online Library+3
You deserve better than that. You deserve early and accurate diagnosis, treatment that respects both your body and your gender, and teams that honor your partners and chosen family.
Many clinicians, researchers, and activists work every day to remove these barriers. The studies in your spreadsheets, and newer work from cancer centers and trans health programs, give those efforts strong support. [1][3][7][11][12][21] Wiley Online Library+5PubMed+5PubMed+5
Your story matters in that work. Your presence, your questions, and your demands for respect help push cancer care toward true safety for LGBTQ people.
References
[1] Kent EE, Wheldon CW, Smith AW, Srinivasan S, Geiger AM. Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors. Cancer. 2019;125(24):4371–4379. PubMed
[2] Lisy K, Peters MDJ, Schofield P, Jefford M. Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care. Psycho-Oncology. 2018;27(6):1480–1489. PubMed+1
[3] Chan ASW, Yuen SK, Lee J, et al. Needs and experiences of cancer care in patients’ sexual and gender minority status. Cancer. 2023;129(15):2380–2396. PubMed
[5] Pratt-Chapman ML, Alpert AB, Castillo DA. Health outcomes of sexual and gender minorities after cancer: a systematic review. Systematic Reviews. 2021;10:183. PubMed+1
[6] Zazzera SK, Jackson VA, Katz IT, et al. Investigating the needs and concerns of lesbian, gay, bisexual, transgender, queer, or questioning cancer patients. Journal of Homosexuality. 2025;72(3):412–440. PubMed+2Taylor & Francis Online+2
[7] Azzellino G, Cobianchi L, Naldini A, et al. Barriers and nursing strategies in oncology care for LGBTQIA+ individuals. Cancers. 2025;17(9):1506. PubMed Central
[8] Wang YC, Chen CW, Yang HL, et al. Care needs, challenges, and experiences of sexual and gender minority cancer survivors in Taiwan. J Pediatr Adolesc Gynecol. 2024. ScienceDirect+2PubMed+2
[10] Cheung CK, Aneja S, Boehmer U. Disparities in cancer care among sexual and gender minority populations. Cancer Medicine. 2023;12(18):19817–19828. Wiley Online Library
[11] Bybee SG, Spigel DR, McNally B, et al. Why good cancer care means gender-affirming care for transgender patients. Journal of Clinical Oncology. 2023;41(22):3883–3886. PubMed Central+1
[12] Cathcart-Rake EJ, Ruddy KJ, Kenworthy HE, et al. Cancer care for transgender and gender diverse people. CA: A Cancer Journal for Clinicians. 2025;75(1):36–57. PubMed Central+1
[13] Berner AM, Boskey ER, Feldman JL, et al. The implications of hormone treatment for cancer risk and diagnosis in transgender and gender-diverse individuals. Seminars in Oncology. 2024. ScienceDirect+2Dana-Farber Cancer Institute+2
[14] Domogauer JD, Alpert AB, Margolies L, et al. Cancer care considerations for sexual and gender minority patients. Oncology Issues. 2019. And Smart AC, Oliver DE, Goodwin CR, et al. Gender-affirming surgery and cancer: considerations for radiation oncology. Int J Radiat Oncol Biol Phys. 2023. /+1
[15] Shires DA, West A, Patel K, et al. Healthcare experiences among Black and White sexual and gender minority cancer survivors. Cancer. 2025. PubMed+1
[16] Andac-Jones E, Dowling A, Keogh D, et al. Understanding barriers to LGBTQ+ cancer clinical trial participation. Journal of Clinical Oncology. 2023;41(16 suppl):e18675. ASCOPubs
[17] Association of Community Cancer Centers. Trans-inclusive cancer care: why it is an important part of health equity. 2023. /
[18] Memorial Sloan Kettering Cancer Center. Compassionate cancer treatment for transgender people. 2024. Memorial Sloan Kettering Cancer Center
[19] Fight Colorectal Cancer. LGBTQ+ and colorectal cancer. 2025. Fight CRC
[20] Deutsch MB, ed. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people, 2nd ed. UCSF Gender Affirming Health Program, 2016; plus Endocrine Society clinical practice guideline on gender dysphoria and gender incongruence, 2024, and WPATH Standards of Care, version 8. Transcare UCSF+2Endocrine Society+2
[21] Beaton S, et al. Barriers to cancer care in the LGBTQ+ community. Journal of Surgical Oncology. 2024.