23andMe is committed to providing an inclusive and welcoming product experience for all of our customers, but we recognize that there are many aspects that could be improved for LGBTQ+ customers — particularly those who are transgender, non-binary, and intersex. One of those aspects is how we communicate health risks and information about various health conditions and traits.
We are committed to providing accurate and reliable health information to all of our customers, including those who identify as LGBTQ+. However, we acknowledge that there is a significant lack of data on how certain interventions, environmental factors, and social factors impact health risks in individuals who are transgender, non-binary, and intersex. For example, gender-affirming hormone therapies may impact risks for certain cancers.
How is my self-reported birth sex used in the BRCA1/BRCA2 (Selected Variants) and Hereditary Prostate Cancer (HOXB13-Related) Genetic Health Risk report*, and why did 23andMe make that decision?
A person's risk of developing certain types of cancer depends in part on their birth sex. For example:
- Breast cancer: Everyone is at risk of developing breast cancer, but breast cancer risk is much higher in people whose sex assigned at birth is female than in people whose birth sex is male.
- Prostate cancer: Everyone with a prostate is at risk of developing prostate cancer. This includes cisgender men, transgender women, non-binary individuals who have a prostate, and intersex individuals who have a prostate. People without a prostate — including cisgender women and transgender men — are not at risk.
- Ovarian cancer: Everyone with ovaries is at risk of developing ovarian cancer. This includes cisgender women, transgender men, non-binary individuals who have ovaries, and intersex individuals who have ovaries. People without ovaries — including cisgender men and transgender women — are not at risk.
The impact of genetics and other factors on cancer risk has been studied primarily in cisgender individuals (people who identify with their birth sex), and the risk estimates provided in the BRCA1/BRCA2 (Selected Variants) and Hereditary Prostate Cancer (HOXB13-Related) Genetic Health Risk reports are based on those studies.
Given the current state of research, we rely solely on the birth sex you selected in your account settings to interpret your genetic results for these two reports, and for some other Health reports where birth sex impacts the chances of developing a condition.
For example, if you select "female" as your birth sex, your BRCA1/BRCA2 (Selected Variants) Genetic Health Risk report will provide information on whether your genetic result is associated with an increased risk for breast cancer, ovarian cancer, and certain other cancers like pancreatic cancer. If you select "male," then the report will focus on male breast cancer, prostate cancer, and certain other cancers like pancreatic cancer.
Within these reports, we use the word "male" to refer to people whose birth sex is male and have a prostate and not ovaries, and "female" to refer to people whose birth sex is female and have ovaries and not a prostate. We made this decision as a way of highlighting that certain cancer risks depend on which reproductive organs a person has. However, we recognize that being categorized by birth sex may be an uncomfortable or triggering experience for some people, and we do not mean to delegitimize anyone's gender identity or expression. Keep in mind that you can always change your self-reported birth sex in your profile from within your account settings.
How is my self-reported gender used in the BRCA1/BRCA2 (Selected Variants) and Hereditary Prostate Cancer (HOXB13-Related) Genetic Health Risk reports?
If you indicate your gender is not the same as your birth sex, you will receive messaging on the Health Overview page that indicates our Health reports are based on your self-reported birth sex. We also provide additional messaging at the top of the BRCA1/BRCA2 (Selected Variants) and Hereditary Prostate Cancer (HOXB13-Related) Genetic Health Risk reports for customers whose gender is not the same as their birth sex. Keep in mind that you can always change your self-reported gender in your profile from within your account settings.
We understand that the words "male" and "female" may not accurately reflect an individual's gender identity. However, because our reports are based on scientific studies done primarily in cisgender individuals, we are unable to provide information specific to non-cisgender individuals at this time. We will continue to monitor research in this area and as we learn more, we hope that we'll be able to provide more tailored information to transgender, non-binary, and intersex individuals.
- UCSF Gender Affirming Health Program: The University of California San Francisco offers guidelines for the primary and gender-affirming care of transgender and gender non-binary people. Its resource center includes guidelines for breast cancer screening in transgender men and for breast and prostate cancer screening in transgender women.
- World Professional Association for Transgender Health (WPATH): WPATH is a non-profit, interdisciplinary professional and educational organization devoted to transgender health. Their mission is to promote evidence based care, education, research, public policy, and respect in transgender health. They have published Standards of Care for the Health of Transgender and Gender Diverse People. They also have a directory to help you find a healthcare provider who is a WPATH member.
- LGBTQ+ Healthcare Directory: The LGBTQ+ Healthcare Directory is a free, searchable database of healthcare professionals. Each provider is knowledgeable and sensitive to the unique health needs of LGBTQ+ people in the USA and Canada.
- Prostate Cancer Foundation: The Prostate Cancer Foundation is a philanthropic organization dedicated to funding promising research to improve the prevention, detection, and treatment of prostate cancer. They provide several helpful guides, including Special Considerations for Gay and Bisexual Men and Trans Women.
- Prostate Cancer UK: Prostate Cancer UK is a non-profit organization that funds research aimed at finding better treatments and screening tests for prostate cancer. They provide a detailed FAQ page focused on prostate cancer in transgender women.
*The 23andMe PGS test uses qualitative genotyping to detect select clinically relevant variants in the genomic DNA of adults from saliva for the purpose of reporting and interpreting genetic health risks, including the 23andMe PGS Genetic Health Risk Reports for BRCA1/BRCA2 (Selected Variants) and Hereditary Prostate Cancer (HOXB13-Related). Your ethnicity may affect the relevance of each report and how your genetic health risk results are interpreted. These reports are not intended to diagnose any disease and do not describe a person’s overall risk of developing any type of cancer. They are not intended to tell you anything about your current state of health, or to be used to make medical decisions, including whether or not you should take a medication, how much of a medication you should take, or determine any treatments. Warnings & Limitations: The 23andMe PGS Genetic Health Risk Report for BRCA1/BRCA2 (Selected Variants) is indicated for reporting of 44 variants in the BRCA1 and BRCA2 genes. The report describes if a person's genetic result is associated with an increased risk of developing breast cancer and ovarian cancer and may be associated with an increased risk for prostate cancer, pancreatic cancer, and potentially other cancers. The variants included in this report do not represent the majority of the BRCA1/BRCA2 variants in people of most ethnicities. The Hereditary Prostate Cancer (HOXB13-Related) Genetic Health Risk report is indicated for reporting the G84E variant in the HOXB13 gene. The report describes if a person has the G84E variant and if a male is at increased risk for prostate cancer. The variant included in this report is most common in people of European descent, especially in people of Northern European descent. These reports do not include variants in other genes linked to hereditary cancers and the absence of variants included in this report does not rule out the presence of other genetic variants that may impact cancer risk. These reports are for over-the-counter use by adults, and provide genetic information to inform discussions with a healthcare professional. The PGS test is not a substitute for visits to a healthcare professional for recommended screenings or appropriate follow-up. Results should be confirmed by an independent genetic test prescribed by your own healthcare provider before taking any medical action. For important information and limitations regarding genetic health risk reports, visit https://www.23andme.com/test-info.