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Background
In the United States, approximately 1.6 million individuals ages 13 and older identify as transgender. The term "transgender" describes any individual whose gender identity, or inner sense of self, differs from their sex assigned at birth. Transgender patients have been marginalized historically. However, with increasing public acceptance and prevalence of gender-affirming care, radiologists need to be aware of the unique considerations for this minority patient population. This is especially true in breast imaging because breast cancer is typically portrayed as a women’s cancer, leading to gender bias in a medical setting that can feel unwelcoming to transgender patients. Gender-affirming interventions impact an individual’s risk for breast cancer and alter the imaging appearance of the breast or chest. Knowledge of screening guidelines and specific risk factors, such as prolonged exposure to exogenous hormonal therapy, are key for the appropriate management of transgender patients in breast imaging. The goal of this exhibit is to provide a multifaceted review of breast imaging considerations in transgender patients.

Educational Goals / Teaching Points
Review appropriate transgender terminology. Explain how to make breast imaging facilities more inclusive to a gender diverse population. Discuss methods of making breast imaging reports more gender neutral. Review relevant gender-affirming interventions in transgender patients. Summarize current screening guidelines for breast cancer in transmasculine and transfeminine patients. Discuss optimal breast imaging techniques for the transgender patient. Review common imaging findings and possible pathologies seen in transgender patients in a case-based format.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Multimodality imaging with mammography, ultrasound, and/or MRI may need to be utilized to adequately evaluate benign and malignant pathologies that impact the transgender patient. Several techniques should be utilized to optimize imaging for transgender patients. Free silicone injections could provide challenges in evaluating the breast tissue and obscure potential cancers. Additionally, postmastectomy complications in transgender men (i.e., seroma or abscess) may require detailed evaluation and possible intervention with ultrasound-guided aspiration. Understanding the spectrum of imaging findings seen after gender-affirming therapy can help guide appropriate radiological care.

Conclusion
The transgender population disproportionally experiences disparities due to a lack of provider knowledge in caring for this minority population. Radiologist familiarity with screening recommendations, gender-affirming interventions, and diverse pathologies seen on imaging is crucial for improving breast health outcomes. This exhibit will also explore the variety of considerations that are key for creating an inclusive environment in a breast department while optimizing imaging and individualized care.