This study examined prostate size and characteristics in transgender females (TF) receiving hormone therapy (HT) and androgen deprivation (AD). Although gender-affirming surgery may include orchiectomy and vaginoplasty, most TF and gender-nonconforming individuals who were assigned male at birth retain their prostate. Understanding how the prostate responds to long-term hormone treatment is important because current prostate cancer screening guidelines are largely based on cisgender men who have not undergone androgen deprivation or oestrogen therapy. Researchers conducted a retrospective review of 60 TF patients receiving HT who underwent transrectal prostate ultrasound between 2021 and 2022. All participants were confirmed to be receiving AD and HT. The researchers recorded prostate volume, age, duration of hormone therapy, age when HT began, surgical history and available PSA levels. The average prostate volume was 14.1cc, with a median of 12.4cc. Prostate size was significantly smaller than reported population averages and age-matched cisgender male controls. However, older age and starting hormone therapy later in life were both associated with larger prostate size. Importantly, the age at which hormone therapy began was approximately twice as influential in predicting prostate size as the duration of hormone therapy. The study also found that some TF patients over 50 had prostate volumes greater than 40cc, indicating that benign prostatic hyperplasia (BPH) can still occur despite androgen suppression. PSA levels were generally very low; among seven patients with available results, the mean PSA was 0.06. No patients in the study had prostate cancer, although two had previously undergone biopsy for elevated PSA. The authors conclude that prostate disease should not be assumed to be absent in TF receiving long-term AD or HT. BPH should be considered in TF over 45 with urinary symptoms, particularly those who began HT later in life. For prostate cancer screening in TF over 50, the authors recommend individualised, shared decision-making that considers age, family history, age at hormonal transition and other risk factors. The study’s conclusions are limited by its small sample size, single-centre design, and lack of longitudinal data.
