What Transgender Women Need to Know About Their Risk of Prostate Cancer

It’s pretty well known that prostate cancer is a disease that should be on every man’s radar. After all, it's the most common cancer among American men, and an estimated 161,360 new cases of the disease are expected to be diagnosed this year, according to the American Cancer Society. But things are a little more muddled for transgender women—and experts say that trans women need to be aware of their prostate cancer risk.

Basically, if you have a prostate, you're at risk of developing prostate cancer.

Even people who have undergone gender-affirming surgery will typically still have a prostate, Zil Goldstein, assistant professor of medical education and program director for the Center for Transgender Medicine and Surgery at Mount Sinai Health System, tells SELF.
Prostate cancer can and does happen to transgender women. A 2013 case study published in the Canadian Urological Association Journal, for example, reports the case of a transgender woman who was diagnosed with metastatic prostate cancer (meaning, it had spread beyond her prostate to other parts of her body), 31 years after she transitioned. Another case study published in JAMA tells the story of a transgender woman who was diagnosed with prostate cancer 41 years after her transition.
According to the University of California, San Francisco Center of Excellence for Transgender Health, there have been cases of prostate cancer in transgender women with a variety of surgical histories and hormone therapies, meaning it's hard to say that any one surgery or hormone therapy would obliterate your risk. However, most cases of prostate cancer in transgender women have involved people who started hormone therapy later in life.
“We don’t have any data specific to transgender women,” Goldstein says. “For any given person with a prostate, there’s an 11.6 percent chance that they’ll develop prostate cancer in their lifetime.” If you’re a transgender woman, that number could apply to you; but it depends on what your transition has included.

For transgender women who have had gender-affirming surgery or are on hormone therapy, the risk of prostate cancer seems to be very low.

“But if you have transgender women who haven’t been on hormones, then their prostate cancer risk is the same as cisgender men,” Asa Radix, M.D., M.P.H., F.A.C.P., director of research and education at Callen-Lorde Community Health Center, tells SELF. “It really is about whether or not they’re having interventions.”
Prostate cancer treatment for cisgender men typically involves testosterone blockers and estrogen, which is common for transgender women on hormone therapy, Dr. Radix points out. “Many transgender women already have prevention treatment on board,” he says. “That’s probably why the rates are so low.”

So, should you be screened for prostate cancer?

First, let's start with the screening recommendations for cisgender men. According to the American Cancer Society, men should not be routinely screened for prostate cancer until they have a conversation with their doctor about their personal risks and the potential for uncertainty with results. Men who proceed with screening may be given a prostate-specific antigen (PSA) blood test (which can indicate an abnormal cell count in the prostate gland) and/or a digital rectal exam.
The screening process is similar for transgender women. It’s not currently recommended that doctors regularly screen transgender women for prostate cancer, Dr. Radix says; but doctors are encouraged to have a conversation with patients about their family history of prostate cancer and any symptoms, which can include burning during urination, trouble urinating, and pelvic discomfort. If a transgender woman has these symptoms or a strong family history of the disease, a prostate exam may be warranted, which can be done rectally or through a vaginal exam. Transgender women can also have a PSA test. However, Goldstein says this number may be lower in transgender women who are on hormone therapy, so doctors are encouraged to double the number to get a more accurate figure.
If you still have a prostate, Dr. Radix says it’s important to remember that you may still be at risk for prostate cancer, which means that you should talk to your doctor about screening. You can search for LGBT-friendly doctors at places like: GLMA.orgWPATH.org, or trans-health.com.