Reading about topics related to your health can be really frustrating. There’s a lot to figure out, plenty to worry about and all kinds of questions you can’t possibly answer on your own. And when you’re transgender or nonbinary, it can be even more frustrating — not to mention triggering — to read repeated references to sex and gender that seem to exclude you from important conversations about your own health.
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You may be wondering: Why do doctors and healthcare resources need to mention sex, anyway? Why should it matter? At this point, can’t we do away with those references altogether?
Certified nurse practitioner Kinsey Kolega, CNP, explains some of the ways that the sex you were assigned at birth can have an impact on your health (and when it really doesn’t matter) so you can make the best and most informed decisions for yourself and your body.
What do AFAB and AMAB stand for?
AFAB means “assigned female at birth,” while AMAB means “assigned male at birth.” You might also see DFAM, meaning “designated female at birth,” and DMAB, meaning “designated male at birth.”
“These terms refer to how society perceives us as being male or female when we’re born,” Kolega explains. “When a baby is born with a penis, that baby is typically considered a male, while a baby born with a vagina is designated female.”
But those labels don’t always hold true as you grow up and figure out your gender identity. Terms like “transgender,” “gender nonconforming,” “genderqueer” and “nonbinary” are identifiers people use to convey that their gender identity doesn’t align with the sex they were assigned at birth.
Why are these terms important in healthcare?
Words matter. It can be frustrating and triggering when the words that are used to describe you don’t match up with who you are, like when providers continually use the terms “man” and “woman” to talk about certain conditions.
A trans woman who needs a prostate exam, for example, may be upset when prostate exams are referred to as “men’s health.” A nonbinary person who has a uterus might also rightly balk at phrases like “mother-to-be” and “the female reproductive system” in reference to their pregnancy.
All of this can make it difficult to want to engage with medical information that will help you take care of your body. “When you feel excluded from conversations about health, you may feel alienated by and isolated from the healthcare system, which could prevent you from seeking care,” Kolega says.
Why are AMAB and AFAB the preferred terms?
“In cases when it’s important to discuss somebody’s anatomy, the terms AFAB and AMAB are more gender-affirming than, for example, ‘born female’ or ‘biologically male,’” Kolega explains. “Those terms can be invalidating by implying that a trans person isn’t ‘actually’ a man or a woman. They also don’t include people who are intersex and have different anatomy.”
Language is constantly evolving, as is our understanding of it, and that’s especially true in healthcare. Some words that used to be considered appropriate, and even medically correct, are now considered hurtful and offensive — words you’d never consider using today. It’s very possible, then, that AFAB and AMAB won’t always be the right terms to use.
At this time, though, they’re considered the most direct and gender-affirming options for referencing the ways that sex can play a role in health.
“The terms AFAB and AMAB aren’t perfect, but they acknowledge that both sex and gender exist along a spectrum,” Kolega says. “Not everyone is ‘male or female’ or fits into what society thinks of as male or female, in terms of their anatomy or physical presentation.”
A better way to approach health guidelines
In medical guidelines, as in the rest of life, the gender binary often shows up in places where it’s not needed.
Here’s an example: The U.S. Centers for Disease Control and Prevention’s webpage about binge drinking says, “Binge drinking is defined as consuming 5 or more drinks on an occasion for men or 4 or more drinks on an occasion for women.” But what does this mean for nonbinary people? And if you’re trans, how do these guidelines apply to you?
“We have a tendency to separate things more than is necessary,” Kolega says. “In this case, is it really about men versus women? Or is it more about body size?”
Such guidelines are often not even accurate for cisgender people. Think, for example, about a short, small-framed cisgender man versus a tall, muscular cisgender woman. Such binary-focused guidelines likely aren’t the right fit for them, either.
Many health guidelines, including cancer screening protocols, aren’t specific to sex or gender at all. And people of all genders come in all shapes and sizes — so oftentimes, health guidelines that are broken down along the gender binary could just as easily (and much more affirmingly) be separated by height and weight.
How does the sex you’re assigned at birth affect your health?
You may think that the sex you were assigned at birth only plays a role in your overall health if you’re talking specifically about sex organs — and to some extent, that’s true.
“We don’t typically ask people a lot of questions about their genitals unless it pertains specifically to their health, like if you have concerns about sexually transmitted infections,” Kolega says. “But I always tell my patients: ‘If you have the organs, you can get cancer in them.’”
And that line of thinking doesn’t just apply to cancer. If you have a vagina, you can get any condition that affects vaginas; if you have a penis, you can get any condition that affects penises; and so on and so forth, for every body part under the sun.
Your medical providers also need to know whether you’re on gender-affirming hormone therapy, which can impact some of your health risks.
“It’s important that you’re not ignoring major aspects of your health,” Kolega says.
If you’re AFAB…
Even if you’re not a woman, being assigned female at birth is associated with certain health risks that you need to know about and be on the lookout for. Being AFAB puts you at higher risk for conditions like:
- Breast cancer (even if you’ve had top surgery).
- Heart disease.
- Multiple sclerosis.
- Osteoporosis and other bone-related conditions.
- Urinary tract infections.
Remember: If you have an organ, you can develop a disorder related to it. When it comes to your reproductive system, that can mean:
- Cervical conditions, including cancer, polyps, dysplasia and cervicitis.
- Ovarian conditions, including cancer and polycystic ovary syndrome (PCOS).
- Uterine conditions, including cancer, polyps, fibroids and endometriosis.
- Vaginal conditions, including cancer, prolapse and bacterial vaginosis.
And if you become pregnant, you’re still at risk for pregnancy-related conditions and both pre- and post-natal health issues, including postpartum depression.
Health recommendations for people AFAB
If you were assigned female at birth, ask your provider what tests, screenings and exams you may need and when.
This will likely include the recommendation of an annual mammogram (breast cancer screening) starting at age 45, though you may need one sooner, depending on whether you take any hormones. “If you’re uncomfortable with the idea of a mammogram, you can ask whether a breast MRI or ultrasound is an option,” Kolega suggests.
It’s also important to have regular gynecological exams to check for sexually transmitted infections, cancer and other health concerns. If you’re uncomfortable with the idea of a pelvic exam, ask about the possibility of having your ovaries, uterus and cervix removed.
If you’re AMAB…
People assigned male at birth are at a higher risk of:
- Amyotrophic lateral sclerosis (ALS).
- Kidney stones.
- Pancreatitis and pancreatic cancer.
- Parkinson’s disease.
Health recommendations for people AMAB
Your provider can tell you what tests, screenings and exams you may need, including a prostate exam. Even if you’ve had genital surgery, you likely still have a prostate — a small, walnut-shaped gland that’s below your bladder and in front of your rectum.
Anyone with a prostate can develop a prostate disorder, including:
Your risk of prostate cancer increases as you get older, so it’s important to be screened starting around age 55. This exam is usually done via a digital rectal exam or a blood test.
If you’re intersex…
Did you know that being intersex is as common as having red hair? In the U.S., an estimated 1 in 100 people is intersex, while intersex people make up about 2% of the world’s population.
People who are intersex have genitals, chromosomes and/or reproductive organs that don’t fit into a male/female sex binary. Being intersex can mean a higher risk of:
- Bone weakness, including osteoporosis.
- Congenital adrenal hyperplasia, a group of genetic disorders that affect your adrenal glands.
- Hypospadias, a problem with your urethral opening.
- Klinefelter syndrome, being born with an extra X chromosome.
- Mayer-Rokitansky-Küster-Hauser Syndrome, an underdeveloped or missing uterus and/or vagina
- Swyer syndrome, when sex glands don’t develop as expected.
As is the case for everyone else, your unique health risks depend on, well, your unique health, including what organs you have, whether you take any hormones and more. The best way to figure out your health risks is to speak with a healthcare provider.
Talking to your doctor about your gender identity
You may not have spent much time thinking about the evolution of language — or how long it can take to purge outdated language from our cultural lexicon and swap in newer, more appropriate terms.
That can be especially true in a field as vast and ever-changing as the world of healthcare. Unfortunately, medical writing — and medical speak, like the words you see written in your charts — doesn’t always differentiate between sex and gender identity.
What does that mean for you, from a practical perspective? It means that all healthcare providers should be well-versed in providing gender-affirming care — but frustratingly, that’s not always the case. And some providers, although well-intentioned, may not use the proper or preferred terminology, which can make you feel alienated and hurt.
For people who are trans, that alienation can have real medical repercussions. Studies show that, for a variety of reasons, people who are transgender are less likely than people who are cisgender to seek out information about and receive critical cancer screenings. So, finding a healthcare provider you like and trust can go a long way toward helping you feel comfortable seeking care.
“It’s so important to find someone who is knowledgeable about gender diversity, or at least someone who is open and listens to you,” Kolega says.
Try to find gender-affirming care
If you live someplace with multiple healthcare practitioners to choose from, you may want to think about the following tips for seeking gender-affirming care:
- Find an LGBTQIA+ health center. This may not be an option, depending on your location, but if you live near a health center that specializes in LGBTQIA+-affirming care, that’s a great place to start.
- Ask around. Other people in your local LGBTQIA+ community may have recommendations for specific providers. “Word of mouth can be so important,” Kolega notes.
- Do a little research. You can call potential providers’ offices to ask about their level of comfort and experience providing gender-affirming care. This information may also be available on their website or in individual doctors’ online bios.
Be honest with your providers
The sex you were assigned at birth can and does factor into your personal health risks, so it’s something your provider needs to know — even if it’s something you don’t typically share with others. But finding a provider you like and trust can go a long way toward helping you feel comfortable having these conversations.
“The most important thing is finding someone who listens and is open-minded,” Kolega says. “You want a provider who is mindful of different experiences and how you may feel about different parts of your body.”
Share which terminology you prefer
In many providers’ offices, the paperwork you fill out before your appointment now asks for gender identity, the sex you were assigned at birth and the pronouns you use. This allows them to see a fuller picture of your health while also addressing you in ways that are respectful and gender-affirming.
“In my practice, we try to avoid any language that’s heavily gendered,” says Kolega, who works at an LGBTQIA+ health center. “That means not using phrases like ‘women’s health’ when what we mean is ‘the health of people who have uteruses,’ and so on.”
“We also often ask patients what terms they prefer to use for their own anatomy,” Kolega continues. “Some trans women, for example, prefer to refer to their penis as a clitoris or another term.”
If your provider doesn’t ask, you can offer up this information, if you’re comfortable doing so. It will help them know and understand you better and to respect your language choices.
Ask what’s right for you, as an individual
Let’s go back to that example of the definition of binge drinking. We’ve already determined that the gendered guidelines aren’t particularly helpful for transgender, nonbinary or cisgender people, given the vast differences in body types across the gender spectrum. So, what’s the answer?
If you want to figure out a safe amount of alcohol for you to consume, ask your healthcare provider. The same is true for any other guideline or condition. Based on factors like your height, weight, family history and overall health, they can provide guidance that is tailored specifically to you.
“Most health risks are dependent upon you as an individual, and your provider’s recommendations should reflect that,” Kolega says.
These conversations are private!
It can feel nerve-wracking and vulnerable to talk to your provider about these topics, especially if you’re not usually open about the sex you were assigned at birth. Remember, though: In the U.S., the Health Insurance Portability and Accountability Act, more commonly known as HIPAA, protects your right to medical privacy.
That means that it’s illegal for healthcare providers — not just doctors, but anyone who provides medical care or works in a provider’s office — to reveal anything about your health without your explicit permission.
“Your health is something that we will never talk about with anyone who is not directly involved in your care,” Kolega says. “It stays between you and your providers.”