Specific malignancies are brought to the public's attention using cancer ribbons. People display their support for those receiving a prostate cancer diagnosis by wearing blue ribbons. Picture from Pexels
Trans women have a prostate, which is a gland that resides below the bladder and encircles the urethra, which is the tube that empties the body's urine.
The prostate in cisgender men is typically a walnut-sized organ that becomes bigger with age. If you're using feminising hormones (oestrogen) or medications that stop androgens like testosterone from having an impact on the body (testosterone blockers, also known as anti-androgens), you won't see as much of an increase in size.
Prostate cancer is dangerous. Fortunately, the majority of men with prostate cancer are identified before the disease has spread past the prostate gland. When cancer is treated at this stage, it frequently vanishes.
However, there has been an increasing recognition of difficulties associated in providing quality healthcare for transgender persons, who frequently experience prejudice and inequality.
Unfortunately, many discussions about prostate health are only directed at cisgender men.
However, whether you identify as a transgender woman or a non-binary person who was born male, you also have a prostate. Therefore, you need to be well-informed on prostate health and the symptoms to watch out for.
Doctors leave the prostate gland in place when beginning hormone therapies to induce feminine sex characteristics in persons going through gender transition since removing the gland might result in urine incontinence and other issues.
In order to suppress testosterone, a male sex hormone, this procedure, known as feminising or gender-affirming hormonal therapy (GAHT), uses drugs and surgery.
Because testosterone fuels prostate cancer, GAHT reduces overall risks for the condition.
However, the authors of a new article claim that transgender women can still get prostate cancer in ways that are still not fully understood: The risk is pegged at 14 occurrences per 10 000 persons, according to a groundbreaking study sponsored by UC San Francisco.
The Veterans Affairs Health System provided data for the study spanning 22 years. The size of the transgender population resulted in a modest sample size, but the study, The Journal of the American Medical Association (JAMA) published it on April 29, 2023, is still the biggest of its kind.
The study identified 155 confirmed transgender women with prostate cancer and divided them into groups based on whether they had ever used oestrogen: 116 of them had never done so, 17 had used it in the past but stopped before being diagnosed with prostate cancer, and 22 were now using it. 88% of the patients were white, and the median age at diagnosis was 61.
Only 8% of people were black, which may indicate that this group faces inequities. Black cisgender men have a higher risk of developing prostate cancer and passing away from it.
The researchers discovered that transgender women are more likely than previously reported to develop prostate cancer, with 14 incidences per 10 000 transgender women annually.
With 33 occurrences per 10 000, the rate was still lower than what would be predicted for cisgender males.
Prostate cancer is generally more common as you age, with men over 65 accounting for around 60% of all cases.
The majority of prostate cancer cases among trans women have been found in those who began gender-affirming hormone therapy beyond the age of 50; however, the study cautions that because prostate cancer frequently grows very slowly, their tumours may have gone undetected before beginning hormones.
Although the current study's sample size was modest, the evidence suggests that transgender women who use oestrogen may have a delay in diagnosis.
The authors also suggested that lower PSA screening rates, incorrect interpretation of PSA values in patients receiving gender-affirming hormone therapy, stigma, lack of knowledge of the risk of prostate cancer, and the effects of oestrogen may have contributed to reduced prostate cancer rates.
The authors of the aforementioned study claim that there is little difference in the signs and symptoms of prostate cancer between transgender and cis-gender people. Most of the time, research has shown that people with prostates can experience the same sort of symptoms.
A frequent and occasionally urgent need to urinate (particularly at night), weak urine flow or flow that begins and stops, pain or burning when you urinate, loss of bladder and/or bowel control, pain in your low back, hips, or chest, and blood in your urine are all possible symptoms of prostate cancer.
However, there are a few additional prostate cancer symptoms that you might not feel or recognise. Depending on whether you've had gender-affirming genital surgery and whether you're taking hormones, some prostate cancer symptoms for trans women may be different or non-existent.
Blood in your semen, erectile dysfunction (ED), and painful ejaculation are examples of symptoms you could have if you haven't had gender-affirming genital surgery and aren't taking gender-affirming medications.
There are no trans-specific screening recommendations for prostate cancer as of yet. However, the most recent recommendations from the American Urological Association apply to all ‘’people for whom prostate cancer screening would be appropriate.’’
Those recommendations suggest that starting at age 50, you should undergo a prostate cancer test every two to four years. After age 70 or 75, screenings often come to an end.
But if you know you're at a higher risk for prostate cancer, such as if you have black ancestry, a significant biological family history of prostate cancer, an inherited gene mutation like BRCA1 or BRCA2, or Lynch Syndrome, talk to your doctor about getting examined earlier.
To find the best prostate cancer screening method for transgender women on oestrogen and other related medications, there is still much study to be done.
This study should serve as a reminder to both medical professionals and patients that everyone who has a prostate is at risk for prostate cancer, regardless of gender.
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