My health care provider is Kaiser and they've turned out to be really good when it comes to trans health care. Or rather, they've evolved into being really good (they didn't start out that way and they still have pockets of resistance).  Anyway, my new primary care provider person has made a point on staying informed with how trans health care should be (& apparently gets some sort of internal encouragement to do so from Kaiser). I finally have someone who doesn't start each appointment with, "So, are you still transgender?" or get all nervous and awkward!  But this also means that for the first time, my health care provider has said,

"So, in April I'm going to set you up for your first mammogram...and prostate exam."

To which I replied something like, "That's new"

I don't know how I feel about this.

I'm worried about the mammogram b/c everyone will know I'm trans & I feel like I'm...intruding, or forcing people to see me as a woman. I'm only out everywhere/time except work so I'm not full time.   I think i can handle that part. What really worries & scares me is the mental / emotional effect having a prostate exam will have on me.

(Backstory: Eight years ago I had to have surgery to fix a fluid build-up in my scrotum. Surgery worked, it looked "perfect" afterward...which triggered a massive collapse of the repression I'd had for decades. As a child I fully expected to someday come out of surgery with them *gone*, not perfect.)

So, apart from that maybe unique baggage, how do you mentally / emotionally handle prostate exams - or for pre-/non-op trans men, gynecological exams & mammograms? I'd like to be prepared instead of having to clean up an emotional mess afterward.

Being 100% honest, I avoided them. I had a consult for my hysterectomy last week and had to admit that my last pelvic exam was over a decade ago. The doctor was very sweet about it, especially considering I'm not sexually active with men, and those kinds of cancers/conditions don't run in my family. I never once had a mammogram, and I didn't have top surgery until I was 26. I'm very, very thankful to be having everything taken out this week.

In general, I just disassociate during most doctor's visits. I'm totally fine being poked and prodded and asked invasive questions in the name of health care, but emotionally I'm very much not present.

I haven't started HRT yet but I get through a prostate exam with humor.  I told my urologist last time if he found what was left of my dignaty to let me know.  Monday I get the fun of telling him I'm transgender and my therapist is recommending me for both HRT and an orchiectomy.  Since he's been treating me for orchalgia, maybe he will do the orchi so medicare and my insurance will cover it.

After you've had a colonoscopy and woken up in the middle of the procedure a prostate exam is easy.  LOL


Sapere Aude

I am pre everything so I can't comment on the weirdness of a prostate exam while presenting as female.

But having a prostate exam is a normal part of having a male body.  The first time, the doc didn't tell me what was happening and I was like WTF??  But since then, it has been routine.  Male doc, female doc, no difference.

The last few years, I have had several colonoscopies.  As Deborah says, after they stick a camera up there, a prostate exam is no big deal.

One hint if you've never had one before: make sure your bladder is empty!

Grin and bear it. Although to be honest I want object completely in regards to having them, but I know they are necessary so I put up with them. Hugs
Mariah

Prostate exams are over pretty quickly, it's a mild discomfort and then it's done. Better that than ending up with prostate cancer.

Since genetic men can get breast cancer (and not just those with moobs) I suspect it is not totally out of the ordinary for them to screen cis genetic men. As you say the clinic is making steps towards being more trans friendly, so if someone has a problem with you that is their problem - report them if they treat you poorly.

My last PCP, who was awesome, told me that men get mammograms.

I have had varying degrees of success in getting through GYN exams. I was able to go the whole bravado route before I came out fully and started transitioning. After that, not so much. My blood pressure goes through the roof, and I become sort of grim and uncommunicative. I completely disassociated one time. I react when touched. Sometimes I'm fairly rational and can answer questions, but I was babbling randomly and rather incoherently the time before last, and the last time? I nearly passed out when I was taken into the exam room.

I just tell myself that this is something that has to happen, and I get through it somehow. I'm not sure how. I mean, I know that it won't kill me...I know that time will pass and it will be over eventually...and I just do the best I can. I don't have any particular strategy.

I think the worst thing is the replaying that I do all year 'round. Every year, the exam happens once IRL and hundreds of times in my head. If you don't replay, then you experience the event once and that's it.

Based on what I have been told by my non-Kaiser physicians, you may wish to consider the following:

Mammograms are a must, once you reach a certain age.  But for MtF, it is not your chronological age that counts, but the age of your boobs -- how long you have had them.  If you are in a high-risk group (blood relatives who had breast cancer before age 60), start at 25 years.  If normal risk, you can wait to 35 years.  After that go annually.

You should be able to judge your prostate health through a PSA count during blood tests.  As the treatment for an enlarged or cancerous prostate is estrogen, if you are on HRT the likelihood of prostate cancer are minimal, at best.  Unless your PSA count is above 6, or shows a steady rise over the years, you can consider a prostate exam as optional.  Even if you were to have a problem, most prostate cancer patients, even of untreated, die of something else first.  The anxiety about prostate problems is that if can affect male sexual functioning -- something you no longer need to worry about, at least for yourself.

Bottom line, however, is that Kaiser is a HMO.  As such, they gain nothing by having you do unnecessary tests; it costs them money.  So if your specialist physician says you need a test, then you do.