The risk of breast cancer in transgender individuals, transgender men (TM) and transgender women (TW), is a topic of interest in the medical community due to the differences in incidence and risk factors when compared to the cisgender population. It has been observed that transgender men have lower age-adjusted rates of breast cancer than cisgender women, possibly due to the high incidence of mastectomies and the effects of testosterone hormone therapy. Testosterone, used in hormone therapy regimens in this population, can affect the histology of the mammary gland and potentially stimulate mammary glandular tissue through its conversion to estradiol. Additionally, the presence of androgen receptors in certain breast cancers suggests a possible relationship between testosterone and cell proliferation in this tissue. As for transgender women, an increased risk of breast cancer has been observed compared to the cisgender male population and a decreased risk compared to the cisgender female population. Hormone therapy with estrogen in transgender women can influence breast development, and hormone replacement therapy in this population often involves higher doses and longer-term estrogen exposure. In terms of breast cancer screening in transgender individuals, current recommendations are based on factors such as assigned sex at birth, previous or current hormone therapy, and prior breast surgery, among others. However, the lack of specific guidelines for this population poses challenges in the early detection of this condition. In conclusion, there are limitations in interpreting the true risk of breast cancer among transgender individuals, including the lack of adequately designed long-term studies that accurately define the best strategy for the timely detection of this condition.