Health Care in Transition

The nation’s cancer care system is becoming more aware of, and sensitive to, the needs of the LGBTQ community.
When Karl Surkan, a transgender man, was diagnosed with breast cancer in 2013, he was seriously considering transitioning from female to male. A few years earlier, after having two children and breastfeeding, he had put off making the decision. But when he received the cancer diagnosis, and with breastfeeding behind him, he was ready to move forward.

“This seemed to be the moment to transition, because having a mastectomy was a treatment option,” says Surkan, who is 48 and was treated at Dana-Farber Cancer Institute in Boston.

Surkan was fortunate. The doctors found the tiny, invasive tumor, which was estrogen-receptor positive, at stage 1. He opted for a double mastectomy, and was then prescribed an estrogen-reducing aromatase inhibitor. The intensity of the side effects he experienced helped determine his next steps.

“I had extreme hot flashes and significant sleep loss, problems that were not remedied by taking antidepressants or through less conventional treatments, like acupuncture,” Surkan says. “I asked my doctors about taking testosterone to address these issues, but they told me they didn’t know if it would cause the cancer to recur, largely because little research has been done on the impact of testosterone on breast cancer survivors.”

Despite the lack of evidence, Surkan forged ahead. So far, the outcomes have been positive. He can now sleep better, and the testosterone has facilitated his transition. His story, however, highlights two of the many problems facing lesbian, gay, bisexual, transgender and queer/questioning (LBGTQ) people who receive a cancer diagnosis. Their providers may not know how to resolve complex and delicate medical issues like those Surkan faced, and the research simply isn’t there to guide decision-making.

However, over the past few years, advocacy groups, health centers and research institutions have become more aware of the unique concerns of LGBTQ cancer patients. As a result, some steps have been taken to make changes to the health care system, with the goal of ensuring that LGBTQ cancer patients receive culturally sensitive care.


Liz Margolies, founder and director of the National LGBT Cancer Network, has been looking at how cancer affects the LGBTQ community for many years. Her challenge has been twofold: Persuade the cancer community to care about LGBTQ cancer patients while also making the LGBTQ community more aware of the importance of addressing cancer head-on as a significant health problem.

“Cancer is hard for everyone, but the LGBTQ community faces added challenges,” says Margolies. “The stress of living as a sexual minority can result in a downhill spiral from discrimination. Many people have trouble getting a job, especially if they are gender-nonconforming. As a result, they have an overall lower quality of life and have trouble finding welcoming health care providers. The stress of living as a sexual and/ or gender minority leads many in the community to smoke and drink, both of which raise the risk for cancer.”

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