Is prostate cancer risk low in trans women on estrogen?

Question

Hello doctor,

I am a 49-year-old transgender woman and have been on estrogen therapy for the past six years. My doctor advised that I should still consider prostate cancer screening. My current PSA level is 0.2 ng/mL. I want to know the following:

Do transgender women develop prostate cancer, and if so, how common is it?
After long-term hormone therapy and orchiectomy, is my risk significantly reduced?
Should I continue regular PSA testing, or is ongoing screening usually not necessary in my case?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query.

I truly understand why prostate cancer screening feels confusing and worrying, especially as a transgender woman. Your concern is completely valid, and I appreciate you bringing this up.

You are a 49-year-old transgender woman who has been on estrogen therapy for six years, and you have also had an orchiectomy (surgical removal of the testicles). These two factors are very important when we talk about prostate cancer risk.

Prostate cancer grows mainly because of male hormones, also called androgens (the most well-known one is testosterone). Estrogen therapy lowers testosterone levels. Orchiectomy removes the main source of testosterone in the body.

When these male hormones are very low or absent, the prostate is no longer stimulated to grow or develop cancer. Because of this, long-term hormone therapy and orchiectomy are considered definitive or curative in this context, meaning they almost completely remove the risk of developing prostate cancer.

PSA (prostate-specific antigen) is a blood test that measures a protein made by the prostate. A PSA level of 0.2 ng/mL, like yours, is very low and reassuring. After estrogen therapy and orchiectomy, PSA levels are usually low because the prostate becomes inactive.

The main factor we still need to think about is family history. Did your father, brother, or close male relatives have prostate cancer, especially at a young age?

If there is a strong family history, we sometimes look for inherited (genetic) risks. BRCA 1 (breast cancer gene 1) and BRCA 2 (breast cancer gene 2) are genes. Certain changes (mutations) in these genes can increase the risk of cancers, including prostate cancer.

A genetic test checks whether you carry these changes.
If a high genetic risk is found, your doctor may suggest continued PSA monitoring, even though your overall risk is still much lower than average.

If there is no strong family history or genetic risk, and you have had orchiectomy and long-term estrogen therapy, then the risk of prostate cancer is almost negligible. In such cases, there is no reason for fear, and routine PSA testing is usually not necessary.

The most important step is simply to review your family history. Other than that, based on what you have shared, there is no cause for concern.

Regular monitoring and healthy lifestyle practices. Active surveillance (close observation without immediate treatment). Review after seven days.

I hope this helps.

Please revert in case of further queries.

Thank you.