Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management

healthtransgenderwomenkapak

PROSTATE CANCER RISK AND MANAGEMENT IN TRANSGENDER WOMEN

Süleyman Sağır

Mardin Artuklu University, Faculty of Medicine, Department of Urology, Mardin, Türkiye

Sağır S. Prostate Cancer Risk and Management in Transgender Women. Balsak D, Aksin Ş, eds. Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.207-214.

ABSTRACT

Transgender women (TW) undergo hormonal and surgical interventions to achieve physical characteristics that align with their gender identity. This process typically involves androgen deprivation therapy (ADT) and high-dose estrogen replacement. Despite these interventions, the prostate—a male-specific organ—remains intact, and rare cases of prostate cancer (PCa) have been reported in TW individuals. This review comprehensively examines the incidence, etiopathogenesis, diagnosis, and management of PCa in the TW population. Current literature suggests that the prevalence of PCa in TW individuals is lower compared to cisgender men. However, insufficient routine screening and lack of awareness may lead to delayed diagnoses in this group. Diagnostic modalities such as PSA testing, prostate biopsy, and multiparametric MRI can be utilized for comprehensive evaluation. Treatment strategies for PCa in TW individuals are largely based on protocols applied to cisgender men and include active surveillance, surgery, radiotherapy, and hormone therapy. Nevertheless, gender-affirming surgeries may introduce anatomical changes that complicate treatment planning. For instance, the effects of radiotherapy on the neovagina and altered anatomical relationships during surgical interventions must be carefully considered. Due to the limited literature and absence of specific guidelines for PCa management in TW individuals, regular monitoring and baseline PSA measurements before initiating ADT are critically important. Furthermore, multidisciplinary approaches integrating endocrinology, urology, oncology, and mental health services are essential to optimize PCa care in TW individuals. Addressing psychosocial needs and providing culturally competent care can improve health outcomes and quality of life in this population. Future research should focus on enhancing screening protocols, understanding the long-term effects of hormone therapy on prostate health, and developing evidence-based guidelines for TW individuals. Strengthening multidisciplinary care frameworks may further advance health equity and treatment efficacy in this underserved population.

Keywords: Prostatic neoplasms; Transgender persons; Estradiol; Gender ıdentity; Androgen antagonists

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