Anyone with a prostate gland can get prostate cancer. This includes transgender women and nonbinary individuals identified as male at birth.
It’s important to be aware of this, since health care providers may not always provide appropriate screening. If you’re listed as female on your medical records, for example, your doctor may not even know you have a prostate. Because the risk of prostate cancer is lower in transgender females, some providers may even consider screening to be unimportant.
There are few cancer care guidelines specifically for transgender people. But your health care provider should always take gender identity into account when making decisions about prostate cancer screening and treatment.
It can be difficult and uncomfortable for trans and nonbinary people to speak honestly with doctors about the organs associated with their birth gender. But talking honestly is important. If you feel comfortable discussing sensitive issues, you’ll be less likely to put off needed care.
What’s the Risk for Trans Women and Nonbinary People?
Researchers don’t know the exact risk of trans women getting prostate cancer, but they do know that it’s lower than that of cisgender males. (“Cisgender” means the gender a person identifies with matches the sex marked on their birth certificate.) The risk does exist, however.
The risk of prostate cancer in trans women and nonbinary people assigned male at birth increases after age 50, just like it does in cisgender men. If you’re a trans woman over 50, discuss the risk of prostate cancer with your doctor even if you don’t have symptoms.
Trans women and nonbinary people who are Black and those with a family history of prostate cancer may also be at increased risk, although there’s no clear evidence. If you’re Black or have a family history of prostate cancer, screening should begin earlier.
What Role Do Hormones Play?
Your prostate gland typically grows larger with age. If you’re taking female hormones (like estrogen) or medications that block male hormones like testosterone, this increase in size is less likely to happen. If you’re taking female hormones, your prostate may get smaller.
If you’re taking female hormones or testosterone blockers, or had your testicles removed – all of which lower testosterone levels – your risk of prostate cancer is reduced.
Most trans women with prostate cancer started hormone treatment after age 50. There is some evidence that transitioning at an older age increases your risk of getting prostate cancer.
What Are the Symptoms of Prostate Cancer in Trans and Nonbinary People?
During the early stages of prostate cancer, you may have no symptoms. This might be because the prostate doesn’t increase in size with age, like it normally would, for those on estrogen or drugs that prevent androgens (male hormones) such as testosterone.
You may notice urinary problems such as difficulty starting, a weak flow, or needing to pee more often than usual. These issues also may be signs of prostate problems that aren’t related to cancer, such as an enlarged prostate or prostatitis. Genital reconstructive surgery also can cause urinary symptoms and pain.
If prostate cancer spreads to other parts of your body, you may notice other symptoms like back pain or hip/pelvis pain, problems keeping an erection, blood in your pee or semen, and unexplained weight loss. These symptoms can have other causes, but it’s a good idea to tell your doctor about them just in case.
Should Trans Women and Nonbinary People Be Screened?
Absolutely. Health care providers should screen trans women and nonbinary people using the prostate cancer screening guidelines for cisgender men and then modifying them based on the person’s stage of transition. That’s because hormone therapy and surgical procedures may affect the risk level.
How Is Prostate Cancer Diagnosed in Trans and Nonbinary People?
Your doctor will base diagnostic tests on your medical history and any medications or treatment you’re on.
The standard screening tool for cisgender men is a digital rectal exam (DRE). During the test, your doctor inserts a lubricated, gloved finger into your rectum. Since the prostate is just in front of the rectum, any unusual size or shape can sometimes be detected.
This procedure is the same for trans women or nonbinary people with a prostate who have not had genital-affirming surgery or who have had labiaplasty (construction of the labia only). If you’ve had genital reconstructive surgery (vaginoplasty), your prostate can be examined through the vagina.
It’s common for this type of exam to stir up uncomfortable feelings and even gender dysphoria, which is psychological distress that can result when you don’t identify with the sex you’re assigned at birth. For this reason, your doctor should perform the exam with extra care.
Another standard test is the PSA, or prostate-specific androgen test. The test measures a protein in your blood that’s produced by your prostate. It’s normal to have a small amount, and the amount rises a bit as you age. A high amount may indicate prostate problems — but not necessarily cancer.
In addition, your PSA levels are likely to be lower if you’re taking female hormones or testosterone blockers. For that reason, what counts as a normal PSA test result may differ from what’s considered normal in cisgender men.
Your doctor may also order an MRI, or magnetic resonance imaging scan, which uses magnets to provide a detailed picture of your prostate, or a biopsy, a procedure that removes small tissue samples from your prostate to examine under a microscope.
How Can You Be More Comfortable During Health Care Appointments?
It’s always difficult for transgender women and nonbinary people assigned male at birth to seek and receive health care. Some even limit doctor visits due to past discrimination, refusal of care, and harassment.
Here are a few steps you can take to make medical appointments less stressful:
- Expect your doctors and health care providers to treat you with respect, including using your correct name and pronouns. If you don’t feel comfortable, you have the right to see a different provider.
- Keep in mind that you may be seen in a clinic also attended by cis men. When you get there, take your referral letter to the receptionist, who should treat you with courtesy and refer to you by name.
- Know that you don’t have to explain your reasons for attending the clinic to the reception staff or any other patients.
- Ask your primary care provider to share your trans history with other health care professionals so you don’t need to explain your situation each time you see a new doctor.
- Make your appointments for the beginning or end of the day, when it’s less busy, or ask to visit a clinic with a mixed-gender waiting room.
- If it helps, bring someone with you or something to read/do that’s entertaining.
- Ask your doctor to refer you to a counselor if you need support.
- Remember that you’re entitled to get medical care without fear of discrimination. If you face discrimination, don’t be afraid to get a second opinion or find a provider who’s a better fit. The Affordable Care Act forbids providers who get federal funding from discriminating on the basis of gender identity (this includes Medicare and Medicaid).
How Is Prostate Cancer Treated in Trans and Nonbinary People?
If you get prostate cancer, your treatment will be based on your age, general health, and the stage of your cancer. Your doctor also should consider gender identity when planning your treatment and care, including your transition stage.
Some treatments aim to get rid of the cancer, and others aim to control it. Treatment plans may include surgery to remove your prostate, radiation and/or chemotherapy, and hormone therapy. You may not even need treatment. Your doctor may want to monitor your condition for the time being.
One common side effect of treatment is a change in sexual function. For example, if you haven’t had gender-affirming surgery, your erection may not be as firm or be firm for as long. If you receive anal sex, it may not feel the same if your prostate is removed. Get as much information as possible about your treatment options and take time to consider, and discuss with your health professionals, what’s right for you.
We don’t know much about the treatment of trans women and nonbinary people with cancer, because research studies don’t typically ask people about their gender identity. If you’re taking hormones, you’ll probably be able to continue -- although your doctor may alter your medication depending on your prostate cancer treatment. Some treatments aren’t recommended before or after gender affirmation surgery.
Another important part of treatment is having a supportive network of health care providers. Being open with them can make you feel understood and cared for, which gives trans women and nonbinary people more time and energy to devote to their treatment and recovery.