Category: Health

The flu virtually disappeared for two years as the pandemic raged. But influenza appears poised to stage a come-back this year in the U.S., threatening to cause a long-feared “twindemic.”

While the flu and the coronavirus are both notoriously unpredictable, there’s a good chance COVID cases will surge again this winter, and troubling signs that the flu could return too.

“This could very well be the year in which we see a twindemic,” says Dr. William Schaffner, an infectious disease professor at Vanderbilt University. “That is, we have a surge in COVID and simultaneously an increase in influenza. We could have them both affecting our population at the same time.”

The strongest indication that the flu could hit the U.S. this winter is what happened during the Southern Hemisphere’s winter. Flu returned to some countries, such as Australia, where the respiratory infection started ramping up months earlier than normal, and caused one of the worst flu seasons in recent years.

What happens in the Southern Hemisphere’s winter often foreshadows what’s going to happen north of the equator.

“If we have a serious influenza season, and if the omicron variants continue to cause principally mild disease, this coming winter could be a much worse flu season than COVID,” Schaffner warns.

And the combination of the two viruses could seriously strain the health system, he says. The Centers for Disease Control and Prevention estimates that flu causes between 140,00 and 710,000 hospitalizations annually.

“We should be worried,” says Dr. Richard Webby, an infectious disease specialist at St. Jude Children’s Research Hospital. “I don’t necessarily think it’s run-for-the-hills worried. But we need to be worried.”

The main reason the flu basically disappeared the last two years was the behavior changes people made to avoid COVID, such as staying home, avoiding public gatherings, wearing masks, and not traveling. That prevented flu viruses from spreading too. But those measures have mostly been abandoned.

“As the community mitigation measures start to roll off around the world and people return to their normal activities, flu has started to circulate around the world,” says Dr. Alicia Fry, who leads influenza epidemiology and prevention for the CDC. “We can expect a flu season this year — for sure.”

Young kids at especially high risk

The CDC is reporting that the flu is already starting to spread in parts of the south, such as Texas. And experts caution very young kids may be especially at risk this year.

Though COVID-19 generally has been mild for young people, the flu typically poses the biggest threat to both the elderly and children. The main strain of flu that’s currently circulating, H3N2, tends to hit the elderly hard. But health experts are also worried about young children who have not been exposed to flu for two years.

“You have the 1-year-olds, the 2-year-olds, and the 3-year-olds who will all be seeing it for the first time, and none of them have any preexisting immunity to influenza,” says Dr. Helen Chu, assistant professor of medicine and allergy and infectious diseases and an adjunct assistant professor of epidemiology at the University of Washington.

In fact, the flu does appear to have hit younger people especially hard in Australia.

“We know that schools are really the places where influenza spreads. They’re really considered the drivers of transmission,” Chu says. “They’ll be the spreaders. They will then take it home to the parents. The parents will then take it to the workplace. They’ll take it to the grandparents who are in assisted living, nursing home. And then those populations will then get quite sick with the flu.”

“I think we’re heading into a bad flu season,” Chu says.

‘Viral interference’ could offset the risks

Some experts doubt COVID and flu will hit the country simultaneously because of a phenomenon known as “viral interference,” which occurs when infection with one virus reduces the risk of catching another. That’s an additional possible reason why flu disappeared the last two years.

“These two viruses may still both occur during the same season, but my gut feeling is they’re going to happen sequentially rather than both at the same time,” Webby says. “So I’m less concerned about the twindemic.”

Nevertheless, Webby and others are urging people to make sure everyone in the family gets a flu shot as soon as possible, especially if the flu season arrives early in the U.S. too. (Most years officials don’t start pushing people to get their flu shots until October.)

So far it looks like this year’s flu vaccines are a good match with the circulating strains and so should provide effective protection.

But health officials fear fewer people will get flu shots this year than usual because of anti-vaccine sentiment that increased in reaction to COVID vaccinations. Flu vaccine rates are already lagging.

“We are worried that people will not get vaccinated. And influenza vaccine is the best prevention tool that we have,” the CDC’s Fry says.

Fry also hopes that some of the habits people developed to fight COVID will continue and help blunt the impact of the flu.

“The wild card here is we don’t know how many mitigation practices people will use,” Fry says. “For example, people now stay home when they’re sick instead of going to work. They keep their kids out of school. Schools are strict about not letting kids come to school if their sick. All of these types of things could reduce transmission.”

Calif.-based startup Curative offers COVID-19 testing and vaccination services throughout the U.S., but as testing needs have lessened, the company is shifting its focus to launching a new health plan.

Due to the course change, the company is laying off 109 employees in early November. 

The company filed a Worker Adjustment and Retraining Notification Act notice with the state of California. WARN is a U.S. labor law requiring employers with 100 or more employees to provide advanced notification of mass layoffs and plant closures 60 calendar days in advance.

“As the company transitions from COVID-19 testing to launching a new health plan out of Austin, Texas, we are reducing the workforce in some areas of the company and expanding in others,” a spokesperson from Curative told MobiHealthNews. 

Curative will launch its employer-based health plan first in Travis and Williamson counties in Texas, then throughout the state of Texas in the coming year. Subsequently, it plans to offer its plan in additional states.

The plan will offer $0 copays and $0 deductibles for in-network care. To qualify, members must complete a preventative health Baseline Visit within 120 days to continue receiving $0 deductibles, $0 copays and $0 out-of-pocket costs for in-network care. 

THE LARGER TREND

Numerous digital health and health tech companies have announced layoffs since the beginning of 2022.

In June, Carbon Health, a chain of healthcare provider clinics that provides telemedicine, laid off 250 employees, about 8% of the company’s workforce. Carbon gained significant revenue from its COVID-19 services, but the company closed many of those services as the pandemic shifted. 

July saw virtual care company Included Health reduce its employee count by less than 6%, and prescription digital therapeutics maker Pear Therapeutics laid off 9% of its full-time workforce.

Calm, a company that flourished during the pandemic by offering an app to help with meditation, stress, and sleep, let go of 20% of its staff due to what its CEO David Ko said was the company “not [being] immune to the impacts of the current economic environment.” 

Cue Health, which offers an at-home molecular COVID-19 test, laid off 170 manufacturing workers earlier this summer.

Most recently, GoodRx, a company known for its prescription price transparency tools, laid off approximately 140 of its workforce, or about 16% of its employees. The reduction primarily impacted its technology-focused and marketing segments.

Other companies that faced mass layoffs include 23andMe, one of the largest genomic platforms in the U.S., payment company Cedar, healthcare automation company Olive, and AI-back genomic and clinical data company Sema4.

Analysis by Dr. Joseph Mercola
Fact Checked

• September 23, 2022Download PDF

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Indian insurtech startup Zopper snaps up $75M in Series C funding

Zopper, an insurance tech startup in New Delhi, has raised $75 million in a Series C funding round led by Creaegis. The round was also participated by ICICI Venture, Bessemer Venture Partners, and its existing investor Blume Ventures. 

The company operates an API platform for insurance infrastructure and delivers small, personalised insurance products from partner insurers to distribution partners. 

Since launching in 2011, Zopper has partnered with over 150 companies from various industries and is now present in over 1,200 cities in India with a goal to democratise access to insurance distribution. 

Its new funds, according to a report by Tech Crunch, will be used to increase its headcount and look into opportunities to acquire other startups.

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RaphaCure launches mobile corporate health app

Health technology firm RaphaCure has gone live with its mobile health and wellness app for corporate employees.

Launched on Android and iOS devices, the new RaphaCure app hosts the company’s corporate wellness offerings. 

“Corporate customers can now search, connect, and book RaphaCure’s multiple corporate health and wellness packages from their mobile devices,” said CEO and founder Jeyakumar.

Based on a press release, RaphaCure seeks to capture the growing corporate health and wellness market in India, which is estimated to be worth $6.7 billion. 

The app launch comes two months after it released RaphaNeu, its online mental healthcare service package for the education sector.

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HealthEM.AI supports dentists’ decision-making with data analytics

Health data analytics company HealthEM.AI has partnered with US-based dental service  organisation Marquee Dental Partners.

The partnership aims to equip dentists with insights from patient data, ultimately improving clinical outcomes.

“Our goal is to efficiently arm doctors with a set of insights regarding each patient’s current overall and oral health. Insights that are predictive in nature allow doctors to take preventative steps today to avoid future health problems,” explained Marquee CEO Fred Ward.

“HealthEM.AI helps Marquee unlock value from patient and operations data and provides meaningful insights for decision-making that benefit patients and improve clinical outcomes,” added Pradeep Kumar Jain, chief product officer of the Bengaluru-based company.

Pattern Health, which offers a platform for building digital health tools, announced it had raised $3.3 million in Series A funding.

The round was led by the Dr. William H. Joyce Family Office, with participation from existing investors Cofounders Capital, the Launch Place and Triangle Tweener Fund. The startup last announced a $1.5 million raise in February 2021. 

WHAT IT DOES

Pattern provides a no-code platform to help clinicians and researchers create digital health programs like apps, clinical decision support tools and surveys.

The startup also has a distribution service that can assist with licensing, and an exchange where users can find other programs that were built using Pattern’s platform. For example, one tool on the exchange is a home-based cardiac rehabilitation program designed by a specialist at Duke University.

“We talk a lot about being a no-code platform, and that’s really how we’re able to get care programs, clinical decision support tools and surveys up and running very quickly. We provide the service through a program management team to help configure these plans, test them and get them into patients’ hands through clinicians and researchers,” CEO and cofounder Ed Barber told MobiHealthNews.  

“And then, of course, we’ve got the researcher and clinician console to help view data, understand the success of the programs from a statistics perspective, but also manage workflows and patient-level data.”

Barber said academic medical centers are one of Pattern’s core customer groups. The company plans to use the Series A capital to improve the platform to appeal to larger organizations, including adding new EHR integrations and spending on marketing.

“One of the next steps for us is to continue to make it easier and more cost-effective to build a diverse set of programs, but also take that same value to the enterprise level,” he said. “How do we work with larger research groups, with larger academic medical centers, with larger health systems to take advantage of these tools at scale?”

MARKET SNAPSHOT

Digital health funding has fallen so far this year, following the booming investment seen in the wake of the COVID-19 pandemic in 2021, according to a report by Rock Health. However, a recent survey by the American Medical Association found more physicians are adopting digital health tools and see them as an advantage for patient care. 

Overall, 93% of physicians surveyed felt there was some advantage or a definite advantage to leveraging digital health tools in 2022, compared with 85% in 2016. And the average number of digital tools in use by physicians grew to 3.8 in 2022 compared with 2.2 in 2016.

Another company focused on growing the number of digital health tools on the market is Redesign Health, which helps build, launch and find funding for startups. It recently announced $65 million Series C round led by General Catalyst.

Synthace, which raised $35 million in Series C funding last year, offers a no-code tool that helps scientists design experiments. They can run those experiments in their labs, then gather and analyze data within Synthace’s platform.

Blue Cross Blue Shield of Massachusetts will offer a new virtual primary care option next year through partnerships with Carbon Health and Firefly Health. 

The insurer said the offering, available starting Jan. 1, will be included in the “majority” of its commercial health plans. Members will choose a primary care provider through Carbon or Firefly, and they’ll be able to access primary care, mental healthcare and referrals to in-person providers in their network when necessary.

Blue Cross said members can expect a $0 cost share for primary and mental health visits with their virtual care team clinicians, provided they meet requirements from their plans. For instance, Saver/HSA-eligible plan members must first meet their deductible.

“More consumers are using virtual care and experiencing its benefits, including greater convenience and affordability,” Blue Cross chief commercial officer Patrick Gilligan said in a statement.

“We’re excited to offer members access to two primary care practices offering the most comprehensive virtual primary care models we’ve seen. They go beyond traditional primary care to help members take control of their health in a way that’s convenient and fits their lifestyle.”

THE LARGER TREND

A number of digital health companies have launched virtual primary care services, arguing it could be more cost-effective and easier for patients to access. Telehealth giant Teladoc Health first made its primary care program, called Primary360, available to payers last year.

It has since expanded the offering with medication delivery and at-home sample collection for lab tests. The company also partnered with Trustmark Health Benefits to launch a virtual-first health plan.

This spring, CVS Health announced its own virtual primary care service. Amazon could also become a larger player in the space with its planned $3.9 billion acquisition of hybrid primary care provider One Medical. However, not long after it announced the deal, Amazon revealed plans to shut down its telehealth service, Amazon Care, at the end of the year. 

Meanwhile, Firefly Health launched its own virtual-first health plan marketed toward small to midsize employers last year, not long after a $40 Series B raise. 

Carbon Health raised a massive $350 million in 2021. It then acquired remote patient monitoring company Alertive Healthcare, a chain of New Jersey urgent care clinics, two clinic chains in Arizona and California, and a group of clinics in Southern California.

The company hit a bit of a rough patch earlier this summer, like a number of other digital health and health tech companies. It announced it was laying off 250 employees, about 8% of the hybrid care provider’s global workforce.

Led by Ally Bridge Group and with the help of its existing shareholders, venture-backed Ceribell, Inc. has raised $50 million.

The funding was structured as an extension of its $53 million Series C raise, which was announced in April 2021. 

WHAT IT DOES

Ceribell developed a rapid response electroencephalography (EEG) system to make diagnosing neurological patients more efficient. It says that its technology platform addresses the need to diagnose patients suspected of having a seizure more quickly by using its brain monitor for point-of-care seizure triage. 

The company will use the funding to support its ongoing commercial expansion in emergency departments and intensive care units. 

Additionally, the allocation will allow Ceribell to continue leveraging machine learning and improve EEG accessibility for other neurological conditions beyond seizures.

“Based on our progress to date, it is clear that the Ceribell Rapid EEG system is improving the quality of care seizure patients receive in the hospital. We look forward to continuing to bring this novel technology to more ICUs and emergency departments, as well as developing diagnostic and monitoring solutions for additional neurological indications impacting the lives of critically ill patients,” Ceribell’s cofounder and CEO Jane Chao said in a statement.

MARKET SNAPSHOT

Earlier this month, Ceribell announced it has received FDA Breakthrough Device Designation to use machine learning to analyze EEG waveform data to detect evidence of delirium.

The Breakthrough Device Designation isn’t a marketing approval from the FDA, but it aims to accelerate the review of products that could help treat debilitating or life-threatening conditions. The program aims to promptly provide patients and providers with access to medical devices and preserve the statutory standards for the 510(k) clearance. Ceribell’s EEG system has received four 510(k) clearances, with the first coming in 2017.

Another company in the seizure-detection and care space is Epitel, which raised $12.5 million in Series A funding earlier this year to commercialize its wearable EEG system. Zeit is developing a stroke and seizure-detection headband, and picked up $2 million in late 2021.

Hey folks, Board-Certified Health Coach Erin Power is here to talk about social media triggers and tidying up your feed. If you find social media hurting your well-being, we’ve got strategies, tips, and backup! Have a question you’d like to ask our health coaches? Leave it below in the comments or over in the Mark’s Daily Apple Facebook group.

Annie asked:
“I switched to Primal a few months ago, and it’s going pretty well. Before that, I had a long history of on-and-off-again dieting and calorie counting. FINALLY, I’m starting to feel like I can just eat real food and let the weight watching go (without gaining weight in the process). The problem: Part of what helped me go Primal was following hashtags on Instagram like #paleo #primal #keto, etc. This actually helped me stick with it and feel part of a community of people eating this way and loving life. BUT lately I’ve noticed myself getting super triggered by certain posts. Usually these are women who are super thin (maybe anorexic) using paleo and keto hashtags. While I’ve come a long way, I don’t look anything like that. It triggers old habits around food and body image. How do I deal with this but keep the good parts of social media inspiration? Sorry for the long question lol.”

First, welcome to the Primal eating crew, and congratulations on your conscious efforts to surround yourself with supportive messaging and community. Creating a supportive environment is HUGE when it comes to implementing and sticking with habit shifts and healthy change efforts.

I’d like to acknowledge you, as well, for noticing what’s NOT working when it comes to social media and your well-being. That awareness is an overlooked first step of self-care. In the end, we are our number 1 caretakers. By recognizing what is helpful and what is not, you can take steps to choose what truly nourishes you.

Tidy your feed, tidy your mind.

As you mentioned, social media can be a tremendous support for Primal eating and living. In a world where so much messaging (online and IRL) is NOT health conscious, it’s nice knowing you can go online and see or even connect with the many people embracing healthy lifestyles and having fun along the way. Good for you for seeking out community as you make supportive shifts.

That said, social media is a mixed blessing. You never know who or what might enter your feed. This is the case whether you follow certain hashtags or if the platform feeds you “recommended” or “suggested” posts and ads based on your previous activity.

As a Primal Health Coach, I work with many clients who have a history of eating disorders or other unhelpful patterns related to food, eating, and weight loss culture. One of the first things I do is recommend that they take a close look at what content and messaging they’re consuming on a daily basis—including on social media. Is it helpful? Or not so much?

I notice this myself on Instagram from time to time and take immediate, proactive steps to edit out what’s triggering or not serving my best interest. I even have a saying: Tidy up your Instagram feed. Tidy up your mind.

If Instagram is recommending posts that you find triggering and unhelpful, make sure to flag them as “Not Interested.” You do this on the post itself, by clicking the three dots in the upper-right corner to see your options. Of course, if you follow the triggering account, unfollow! You can do so on the person’s profile page or by simply clicking those dots up top for the “Unfollow” option. If a particular hashtag seems to bring lots of triggering posts your way, unfollow that too. If the post is “sponsored,” you’ll see an option to stop seeing the ad.

Put simply: Anytime anything or anyone makes you feel badly about yourself or is derailing your healthy change efforts, take the power back and simply make it disappear. We’re focusing on Instagram, but this applies to all social media as well as other content you’re consuming online or in person. Unfortunately, you will have to do it again and again because this stuff always seems to creep back in. But there is something intentional and empowering about this exercise! If you do this often enough your feed DOES change.

Say no thanks, with care.

Current beauty ideals have come far but still have a long way to go. A lot of social media content tries to convince us to be as lean and light as possible (whether through overt messaging or through what’s implied in images and captions).

Since you’re already embracing a Primal lifestyle, you know that achieving a particular size or shape is not what we’re about. Yes, many folks reach their ideal body composition by eating a nutrient-dense diet comprised of real, whole, minimally processed foods; high-quality protein; healthy fats; fruits and veggies; and high-fat dairy. But the bigger picture is enhanced health, longevity, and vitality inside, regardless of how we look on the outside.

This is true, AND, so long as there are not underlying health conditions and so long as the 10 Primal Blueprint Rules are generally applied with at least 80% consistency, desired changes in body composition tend to happen naturally—without calorie counting or struggle.

As a Primal Health Coach, I see this as the norm with my clients, rather than the exception. I also see it as something that helps many step out of old, unhelpful patterns around food: At long last, they can eat delicious, healthy food in abundance and not worry about unwanted weight gain or trying to fight their body and biology. For most, this is the definition of food freedom.

I want to mention this, in part, because we can never know what people posting on social media are actually going through. I suspect many who post “triggering” content around weight and dieting are actually caught in their own places of suffering and struggle. They have not found the sort of “accidental food freedom” that comes along with the Primal approach to eating, moving, and living.

Rather than blame or shame them (or leave unkind comments), I try to send compassionate thoughts, remove them from my feed, and move on. I’m NOT saying this is easy or that I don’t stay triggered or even angry at times. Truthfully, it can be so, so hard to let a triggering image, caption, or comment go.

But the more we manage to remember that these are humans too, with their own vulnerabilities and places of struggle reinforced by widespread diet and beauty ideals, the more we are actively contributing to changing the current culture.

But back to you, Annie: You’re your number 1 caretaker and need to first and foremost take care of you. I just find considering the wider context helpful in softening the power of triggers, taking empowered action, and moving on.

Social Media Strategy & Support

To sum up:

• DO follow accounts and hashtags that are supportive of your health, lifestyle, and food choices. They are a great source of inspiration, motivation, and community!
• Consider following trusted sources. Mark’s Daily Apple, for instance; or the Primal Health Coach Institute!
• DON’T follow accounts or hashtags that make you feel bad about yourself or otherwise undermine the empowering, healthy changes you’re making.
• Edit your social media feeds regularly, keeping what’s helpful and removing the rest.
• Remember our shared humanness and proceed from a place of compassion and kindness whenever possible. We have no idea what others are going through behind the filtered lens of Instagram and other social media channels.

For anyone needing extra backup amidst the diet culture and unhelpful messaging, consider working with a health coach one-on-one. Imagine if you could take all the tips in a post like this and allllll the information that you’ve been gathering over the decades…and reliably and consistently implement them. That’s where coaches help!

External accountability truly is a game changer, and we can help you stay the course with your goals and navigate tricky social situations online and off. Visit myprimalcoach.com to learn more and get started!

Do you find social media helpful or harmful in your wellness journey? Have any tips to share? Let us know and drop your favorite, most supportive Instagram accounts in the comments!

If you’d like to add an avatar to all of your comments click here!

People of all genders can get breast cancer, so it’s important for trans men and trans women to consider that as part of their health care.

“Anyone who has breast tissue could potentially or theoretically develop breast cancer,” says Fan Liang, MD, medical director of the Center for Transgender Health at Johns Hopkins Medicine in Baltimore.

Many things influence your breast cancer risk, including your own medical history, any family history of breast cancer, whether you have certain genes that make breast cancer more likely, and whether you get gender-affirming treatment.

There aren’t yet official breast cancer screening guidelines that are specific to trans people. But experts do have general recommendations, detailed below.

You should talk with your doctor about what screening you need, when to start, and how often. Of course, if you notice a lump or other unusual breast change, see your doctor to get it checked out. (“Screening” refers to routine checking for possible signs of breast cancer, not diagnosing what a lump or other change may be.)

Breast Cancer Screening Recommendations for Trans Women

Each person is unique. In gauging trans women’s breast cancer risk, one of the factors that doctors consider include whether they are taking hormone therapy, their age, and for how long. That’s on top of all the other breast cancer risk factors a person might have.

Trans women who take estrogen as part of hormone therapy: If you’re older than 50, get a mammogram every 2 years after you’ve been taking hormones for at least 5 to 10 years.

Not all trans women take gender-affirming hormone therapy. Those who do will develop breast tissue. Any breast tissue can develop breast cancer. And estrogen, which is part of this therapy, does raise the risk for breast cancer.

If you start taking estrogen as an adult, it may not raise your risk as much as if you start taking it as a teen because over your lifetime, you’d have less exposure to estrogen. There hasn’t been a lot of research in this area yet, so it’s not clear how much taking estrogen raises risk for people of various ages.

Trans women with the BRCA1 or BRCA2 genes and/or a strong family history of breast cancer: These genes raise your risk of breast cancer. So it’s very important that you discuss with your doctor how to manage this risk, such as with screenings or other preventive care. You may need to start getting mammograms earlier – and get them more often.

“There are other health conditions, not just cancer, that might not make you a good candidate for estrogen,” says Gwendolyn Quinn, PhD, professor of obstetrics and gynecology at NYU Grossman School of Medicine in New York. “That’s why the decision to use hormones should be overseen by a health care provider, but many trans people don’t have access to a clinician and buy their hormones on the internet.”

If you aren’t taking gender-affirming therapy but are considering it, make sure your doctor knows that you are BRCA-positive.

“It’s not a formal recommendation, but there has been talk about testing trans women for BRCA before starting gender-affirming hormones,” Quinn says. “But a lot of people feel that gender-affirming hormones are lifesaving and that it’s unreasonable to ask that trans women get tested first.”

If you do have a doctor and want to get tested for the BRCA genes – and other genes linked to breast cancer – your doctor can help you find out about what’s involved.

Trans women who don’t take hormones: Although there’s no recommended screening timing, be sure to see your doctor if you notice any breast lumps or changes – and tell them about anyone in your family who’s had breast cancer.

Trans women who got breast augmentation: Some trans women choose to get breast augmentation surgery to create the look of breasts. This is done with implants, fat transferred from another place on the body, or a combination of those methods.

Fat transfer uses your own body fat from somewhere else on your body to create breasts, and studies don’t show that this raises breast cancer risk. Today’s breast implants don’t cause breast cancer, either. They have been linked to a low risk of a rare form of cancer called anaplastic large-cell lymphoma (ALCL). There hasn’t been a lot of research on implant-related ALCL specifically in trans women. But in one review, researchers called it a “rare but serious” complication and recommended being aware of the risk and keeping up with any follow-up care after getting the implants.

Breast Cancer Screening Recommendations for Trans Men

Among the many factors that can affect your risk are whether you’ve had “top surgery” to change the appearance of your chest, whether you take testosterone, and whether you have certain genes that make breast cancer more likely.

Trans men who have not had top surgery or who have only had breast reduction: Get a mammogram every year or two starting at age 40.

If you haven’t had top surgery, your breast cancer risk is the same as it was before you transitioned. That’s true whether or not you’ve had a hysterectomy (surgery to remove your uterus). Removal of the ovaries and uterus only somewhat lowers breast cancer risk. Removing the breasts makes the biggest impact on breast cancer risk.

Trans men who have had top surgery: You may not have enough breast tissue to put in a mammogram machine, so your doctor may recommend that you do self-exams and also get breast exams done by a doctor.

Not every trans man gets top surgery. But some do. Top surgery lowers breast cancer risk, but not as much as a mastectomy you’d get to prevent or treat breast cancer.

With a breast cancer mastectomy, the goal is to remove as much breast tissue as possible, including tissue under the arms and on the ribcage. With top surgery, the aim is different: to change the chest’s appearance to be flatter. “The breast mass is removed, but we don’t go after every single cell because it’s not necessary to do that in order to get the overall result that we want,” Liang says.

“How much surgery lowers [breast cancer] risk depends on how much tissue is left behind, including the nipple, where there’s also potential for cancer cells to develop,” Quinn says.

Trans men who have the BRCA1 or BRCA2 gene mutations and have had standard top surgery (but not a complete preventive mastectomy): You may need annual breast cancer screenings. Since you likely won’t have enough breast tissue to put into a mammogram machine, a breast cancer specialist may need to give you a chest exam. It’s important that your doctors know that you are BRCA+ so they can make a preventive screening plan for you based on how much breast tissue you have.

Trans men who take hormone therapy with testosterone: Testosterone suppresses estrogen. So if you take hormone therapy with testosterone consistently over time, your breast cancer risk is likely to be somewhat lower. But if you don’t take testosterone – or if you only take a low dose or take it intermittently – you won’t have that protective benefit.

Regardless of whether or not you take testosterone therapy, there is still at least some risk for breast cancer. Your doctor can advise you about what screening you need.

Finding Gender-Affirming Care

While experts can make recommendations about cancer screenings for trans people, finding a gender-affirming health care provider is easier said than done in some places.

The World Professional Association for Transgender Health has an online directory of providers of gender-affirming care. You may also simply call doctors in your area and ask about their experience with providing care to trans patients.

“If you can’t find a transgender health clinic near where you live, call the doctor beforehand,” Liang says. “Ask about the provider’s experience with transgender preventive care. See how they respond to the question – whether they have an understanding of what you need or whether the question seems to them to come out of left field.” Your health concerns – about breast cancer or anything else – should be taken seriously and treated with respect by your health care team.