Prostate size in transwomen on gender-affirming hormone therapy: Considerations for prostate cancer screening

Introduction: The prostate is generally preserved in transfemales who undergo medical and surgical therapy for their gender dysphoria. Screening for prostate cancer and other pathologies like benign prostatic hyperplasia is important. We studied a cohort of transfemales to better understand the relationship between hormonal therapy, androgen deprivation status, and prostate size. Methods: A retrospective analysis of 60 transfemales was performed. Prostatic size and characteristics were assessed using ultrasound. Hormonal status, duration of hormonal therapy, and age at which hormonal therapy was started were confirmed by patient history and laboratory results. Other patient demographics were noted. Results: All patients were considered androgen-deprived. The mean prostate size was 14.1 cc. There was no correlation between duration of hormonal therapy and prostate size. Increasing age at which hormonal therapy correlated with increasing prostate size. Patients over the age of 50 had increased prostate size; however, it was smaller compared to age-matched cis males. Prostate-specific antigen was also much lower and sometimes undetectable. Conclusion: Transgender females over the age of 50 and those who started hormonal transition later in life had increased prostate size, though significantly smaller than the general population. Prostate-specific antigen was also lower. This is important in counseling of transgender females regarding risks of prostate cancer and other pathologies of the prostate like benign prostatic hyperplasia.