How does prostate cancer affect trans women on estrogen?

Question

Hello doctor,

I am writing in concern for my close friend, who is a transgender woman who underwent gender-affirming surgery years ago but was recently diagnosed with prostate cancer. While she is getting the appropriate oncological care, she is extremely distressed about what this means for her hormonal therapy, especially her estrogen supplementation. She is also unsure whether the hormonal fluctuations from cancer treatment might interfere with her reproductive options.

Is it possible for trans women to preserve fertility or explore IVF with stored sperm if they had it banked before transition?
Could the treatment worsen symptoms like hot flashes or affect vaginal health post-surgery?
She is also asked whether radiation or surgery might influence her ability to have penetrative intercourse in the future.
Can you help us understand how to approach long-term hormonal maintenance, birth control (if needed), and emotional wellness during this time?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Hormone therapy for prostate cancer (a common, often slow-growing malignancy developing in the male reproductive gland, usually as adenocarcinoma) may involve medicines or, in rare cases, surgery to remove the testicles.

Hormone therapy for prostate cancer includes the following approaches:

Medicines that reduce testosterone production. Some medications stop the body from making testosterone by blocking signals from the brain to the testicles. These drugs are known as luteinizing hormone-releasing hormone (LHRH) agonists and antagonists, also called gonadotropin-releasing hormone (GnRH) agonists and antagonists.
Medicines that block testosterone action. These medications, called antiandrogens, prevent testosterone from acting on prostate cancer cells. They are often used together with LHRH agonists because LHRH agonists can cause a temporary rise in testosterone levels before they begin to lower them.
Surgery to remove the testicles (orchiectomy). Orchiectomy is a surgical procedure that rapidly lowers testosterone levels. In some cases, only the portion of the testicles responsible for testosterone production is removed. Surgical hormone therapy is permanent and is used less commonly today.

When hormone therapy is given as medication, also called androgen deprivation therapy (ADT), it may be administered in one of two ways:

Continuous ADT (continuous androgen deprivation therapy) is given without interruption.
Intermittent ADT (intermittent androgen deprivation therapy) is given for a specific period or until prostate-specific antigen (PSA) levels fall to a low range. PSA is a protein produced by both normal and cancerous prostate tissue. Therapy is paused when PSA levels are low and restarted if PSA rises or the cancer progresses.

Early studies suggest that intermittent ADT may lead to fewer side effects while remaining equally effective for some patients. It may also improve overall quality of life compared with continuous treatment.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.