Why is prostate cancer important for transgender women?

Photo Credit: Franziska Neumeister https://www.flickr.com/photos/127085184@N05/A transgender woman will have a prostate, regardless of whether or not she has undergone a gender-confirming surgery, such as orchiectomy or vaginoplasty. During gender confirming surgery, the prostate is typically spared, as its removal is intricate and can lead to complications including urinary incontinence. Therefore, for women who have or have not had genital surgery, it is possible for prostate cancer to develop.

As part of feminizing hormone therapy, trans women often receive estrogen as well as either or both antiandrogens and 5-alpha-reductase inhibitor therapies which creates an environment in which the prostate is androgen-deprived. There are conflicting theories about whether this environment reduces prostate cancer development or whether it may lead to more aggressive prostate cancers.

While there are some anecdotal reports and case studies of prostate cancer among trans women, these number less than ten cases in total. Additional research is needed into the population level risk of trans women and the effects of feminizing hormone therapy on risk.

Both under- and delayed-diagnosis of prostate cancer can occur from a lack of routine prostate cancer screening and from the fact that feminizing hormone therapy lowers the levels of prostate specific antigen (PSA) which is a key indicator used in prostate cancer screening.

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