As transgender women usually keep their prostates even after gender-affirming surgery because of health complications, they also have the risk of prostate cancer, a first-of-its kind study has said. It estimates the risk at about 14 cases per 10,000 people. The study has been published in the Journal of the American Medical Association (JAMA).
Since removing the prostate can lead to urinary incontinence and other complications, doctors leave the gland in place when initiating hormonal treatments to induce female sex characteristics in transitioning people. This process, which is called feminising or gender-affirming hormonal therapy (GAHT), relies on medications and surgery to block testosterone, a male sex hormone. Prostate cancer is fueled by testosterone and therefore, GAHT lowers overall risks for the disease. But transgender women can still develop prostate cancer in ways that remain poorly understood, according to the authors of the study.
“More individuals are openly identifying as transgenders, particularly as advances are made in reducing the discrimination and marginalisation that this group has faced,” said Dr Farnoosh Nik-Ahd, a urologist at the University of California, San Francisco, and the paper’s first author.
“Thus, it’s important to understand their health outcomes and how to care for this population in the best possible way. The study found 155 confirmed transgender women with prostate cancer and stratified them according to whether they had used estrogen: 116 had never used estrogen, 17 had once used estrogen but stopped before they were diagnosed with prostate cancer, and 22 were actively on estrogen. The authors found that prostate cancer occurs in transgender women more frequently than published accounts might suggest, with about 14 prostate cancer cases per 10,000 transgender women.
While the numbers are small, they suggest that transgender women taking estrogen may have had delayed diagnoses. The authors also said that lower rates of prostate cancer might have been due to less PSA screening, misinterpretation of PSA levels in patients on gender-affirming hormone therapies, stigma, lack of awareness of prostate cancer risk and the effects of estrogen.