Thought this was an interesting case study:
- 66 year old trans woman
- started HRT at 54 years old
- had vaginoplasty at 57 years old
- family history of prostate cancer
- had elevated PSA levels & symptoms (including incontinence), was referred to urology
- “transvaginal prostate exam was normal, with no palpable nodularity, asymmetry, or tenderness”
- biopsy confirmed prostate cancer
- surgery through the neovaginal canal failed due to the canal being too narrow, they had to go in laparoscopically (looks like through the outer labia?)
- closure of the wound shortened the vaginal depth, but didn’t reduce width, and patient was able to eventually resume penetrative sex after recovering
- incontinence was never solved, she remained unable to control her urine (possibly due to damage to urethral sphincters)
Also felt this was important to share:
Prostate cancer screening in the TGD population remains an important part of their routine healthcare. The Endocrine Society and the World Professional Association for Transgender Health recommend that transfeminine patients should follow the same prostate cancer screening recommendations as cisgender men;12,13 however, patients on GAHT and who have undergone a bilateral orchiectomy will be androgen-deprived. Therefore, PSA levels will decrease significantly to undetectable levels, and reported values need to be interpreted in this context.1,4 In such cases, where prostate cancer is diagnosed after GAHT, tumor aggressiveness and possible unique driver mutations should be considered with further IHC and WGS testing. Furthermore, prostate examinations can be performed intravaginally for screening after PIV but may be impeded if the neovaginal depth is <13 cm or if there is increased tissue rigidity of the neovagina.14 Ultrasonography and prostate biopsy, if needed, can also be performed through a transvaginal approach.
Prostate cancer risks are vastly diminished for trans women who maintain low testosterone levels, over a twofold decrease.
(For pre/no-op women, testicular cancer rates are not lowered, however.)
And in cisgender men, HRT is the go to method of controlling growth of the cancer in cases where surgical intervention is not needed and/or ruled out.
Looking at the cancer Australia website, prostate cancer is the second most common, and they say that a cisgender man has a 1 in 53 chance of dying to prostate cancer by the time they’re 85.
On top of that, it has a 95% 5 year survival rate.
All of which is to say, I’m happy to roll the dice on this one, rather than dealing with frankly awful experience of a prostate exam
you could always just get PSA levels checked
in this case the symptoms and PSA levels tipped off cancer even when paplation would not have found anything…
the risk is pretty high in cis men, I think one in eight men get prostate cancer, and one in four Black men get it - so if you have spent much time with androgens in your body the risks are high enough it’s worth screening, but the loss of androgens in trans women lowers the risk enough that it seems dubious to me every trans woman should be getting prostate exams at age 50 no matter what…
this patient in particular didn’t start HRT until their mid 50s and their father had prostate cancer - so it makes sense they still got it.