The transgender population continues to grow. Last yr, investigators reported that 1.3 percent of individuals between the ages of 18 and 24 within the United States discover as transgender, in comparison with 0.55 percent of the nation's older adults. This trend has implications for public health, and one issue particularly concerns the chance of prostate cancer amongst transgender women.
Because removing the prostate could cause urinary incontinence and other complications, doctors leave the gland in place when starting hormonal therapy to induce female sexual characteristics in transsexuals. The process, called feminization or gender-affirming hormonal therapy (GAHT), relies on drugs and surgery to dam the male sex hormone, testosterone. Prostate cancer is fueled by testosterone, and due to this fact GAHT reduces the general risk of the disease. But transgender women can still develop prostate cancer in ways which can be poorly understood, in accordance with the authors of the A new paper.
“More and more people are openly identifying as transgender, especially as this group has made strides in reducing discrimination and marginalization,” says Dr. Farnoosh Naik Ahad, a urologist on the University of California, San Francisco. “Thus, it is important to understand their health consequences and provide optimal care for this population.”
Dr. Nik Ahad and colleagues wanted higher insight into prostate cancer incidence and screening rates amongst transgender women, in order that they conducted a comprehensive review of the literature that yielded some remarkable findings. One is that the prevalence of GAHT within the transgender population remains to be unknown. Some studies put the figure at about one in every 12,000 to 13,000 individuals who discover as transgender. But that's likely an underestimate, the authors claim, and it's not broken down by gender.
Questions about GAHT
Similarly, little is thought concerning the effects of GAHT on the likelihood of developing prostate cancer, the team reported. Prostate cancer rates seem like lower in transgender women than in cisgender men (men whose sex matches their gender at birth). For example, one study found just one case of prostate cancer amongst 2,306 transgender women receiving routine health care at a clinic in Amsterdam, Holland, between 1975 and 2006. Women over the age of 17, again a lower rate than cisgender men.
But interpretation of those rates is restricted by the undeniable fact that transgender women often face barriers to care. About a 3rd of them live in poverty, and lots of avoid the health system for fear of abuse. Some scientists suspect that the estrogen given during GAHT may someway contribute to the event of prostate cancer if given long-term. However, more confirmatory evidence is required. Worryingly, one study found that survival amongst transgender women with prostate cancer was worse than that of cisgender men with the disease, yet this study lacked data on using GAHT.
Interpretation of PSA values ​​for specific populations
Dr. Naik-Ahad's team was particularly concerned concerning the lack of guideline recommendations for prostate-specific antigen (PSA) screening within the transgender population. Transgender women will not be mentioned in any of the rules available worldwide, and a PSA cutoff of 4 nanograms per milliliter (ng/ml) of blood – which raises the suspicion of prostate cancer – is taken into account cisgender. is reserved for men. PSA levels generally decrease in people taking GAHT, so the researchers suggest that the range considered normal in transgender women ought to be limited to 1.0 ng/mL. In the absence of more specific guidance, in addition they recommend that individuals who meet the age criteria for PSA screening be tested before starting GAHT, to acquire a baseline value.
Dr. Nik Ahad agrees. “Future research should aim to understand baseline PSA values ​​for sex-confirming hormones, and how to overcome some of the psychological barriers around PSA screening so as not to stigmatize transgender patients,” she says. can go.”