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Prostate Cancer in Men who Became Transgender Women
Sobering Reminder Orchiectomy and Estrogens do Not Eliminate Male Cancer
By Peter A. McCullough, MD, MPH
More and more physicians will be managing the explosion of men who undergo transgender therapies and surgery for gender dysphoria. It is important to remember that these boys and men are still fully male and are susceptible to male cancers including prostate cancer.
Nik-Ahd et al, reported 449 men who undertook hormonal therapy, orchiectomy (castration) or both, yet developed prostate cancer after treatment for gender dysphoria.
The authors reported: “The percentage of patients with biopsy grade group 4 or 5 was 23% (19 of 82) of patients who never used estrogen, 10 (12%) of whom were grade group 5; 25% (4 of 16) of former users, 1 (6%) of whom was grade group 5; and 35% (6 of 17) of active users, 5 (29%) of whom were grade group 5. The median PSA density was 0.21 ng/mL/g for never estrogen users, 0.26 ng/mL/g for former users, and 0.31 ng/mL/g for active users.”
I can tell you this sample likely represents a lower incidence and histologic grade than in routine clinical practice. My interpretation is that ~32 months of estrogen therapy and castration in 2% did not eliminate the burden of prostate cancer. Indeed, it is possible that estrogen use drove a more rapid progression once the cancer formed. These data suggest when it comes to carcinoma of the prostate, men are men, and need standard screening for prostate cancer including digital rectal exam and blood prostate specific antigen testing. Doctors should not be confused into thinking the person in front of them is a women when he is not!
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