Epistemic injustice in preventative cancer care for transgender individuals in the United States

Introduction Transgender and nonbinary (TGNB) people frequently pursue surgical or hormonal gender-affirming medical care (GAMC). While some guidelines acknowledge an impact of GAMC on cancer risk and management, the guidelines are relatively recent and draw on limited data in this area. There are knowledge gaps surrounding the intersection of GAMC and preventative cancer care that affect patient care and experience, which is particularly important for individuals with increased cancer risk.Methods To better understand the intersectional GAMC and preventative cancer care experiences of TGNB individuals, we conducted fourteen semi-structured interviews with TGNB United States (U.S.) residents with increased cancer risk. Using reflexive thematic analysis and applying an interpretivist lens, we conceptualized six themes.Results We found that (1) preventative cancer care and GAMC are intertwined; (2) trustworthiness of healthcare professionals (HCPs) and institutions impacts patient cancer care engagement; (3) cisnormative care infrastructure excludes TGNB patients; (4) institutions and HCPs lack knowledge specific to TGNB patients with increased cancer risk; (5) medical paternalism impedes TGNB bodily autonomy; and (6) rising transphobia in the U.S. sociopolitical landscape influences GAMC and preventative cancer care decisions.Discussion Our findings demonstrate how intersecting systemic barriers, including knowledge gaps, exclusionary care practices, and sociopolitical pressures, contribute to compounded inequities in preventative cancer care and GAMC for TGNB individuals. Epistemic injustice, manifesting as both a dismissal of TGNB patients’ lived experiences and a structural lack of relevant knowledge, underpins many of these challenges. This injustice undermines trust, autonomy, and access to affirming, effective care. Steps to address these injustices include improving HCP education, ensuring consent is fully informed, and making systemic changes in clinical settings.