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Oestrogen and PSA readings

Posted 23 Oct 2016 at 13:05

I've heard that oestrogen, taken as a cross -gender hormone for male to female HRT, can lower PSA readings.

In other words, I presume that a  ( pre- gender reassignment surgery) transgender woman, who, post -prostatectomy,  embarks on HRT, will not be able to rely on changes in PSA reading as part of regular post prostatectomy monitoring. 

I will put this question to the PCUK nurses, as my surgeon seems rather dismissive of any other narrative to prostatectomy than "how's your impotence/incontinence". In the meantime, maybe someone reading this has already faced this situation...


Posted 24 Oct 2016 at 09:00

Thanks for the input Andrew. I think you're  correct when you say an oncologist is more likely to know about this than a surgeon. But as I've never seen an oncologist, I'd first have to get a referral, wait a long time, all to (possibly) get a useful answer to a single question.

I'm not sure what you mean about PSA. Surely the changes and trends in post prostatectomy PSA are the earliest indicators that all is not right and further investigation is indicated. I think that this is what they mean by biochemical recurrence. Often the individual with biochemical recurrence is otherwise symptom free.

Perhaps you mean looking at trends in PSA. Well, what if I had a PSA of 0.1 post op, took oestrogen, which knocked back the PSA to 0, but on subsequent testing in the years ahead, it began to rise to '0.1' only when the PSA would actually have been 2.5, had I not taken oestrogen?  

The cancer is the thing to keep track of, and PSA is the tracker, but if the tracker's not reliable under certain circumstances, then metastatic symptoms might be the first thing noticed.

Waiting 'til other things become apparent would be leaving things rather late.

Edited by member 24 Oct 2016 at 09:09  | Reason: Not specified

Posted 25 Oct 2016 at 14:07

Hi Patrick,
I think the problem is that very little has been done up to now to begin to understand the PCa journey for transgender folk or those in transition. As you will know, oestrogen is still used as a treatment for PCa in some circumstances so any oncologist (if he could be bothered - how frustrating for you) should be able to discuss with you what the impact is likely to be for you. PCUK are also beginning to get their heads around this topic so a call to them is a good idea - they may also know of an oncologist developing expertise in transgender issues?

I think what Heenan was trying to say was that sometimes an inexpicable fall in PSA is also a very serious red flag. This needs to be considered as part of your ongoing care.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 25 Oct 2016 at 16:10

Thanks, Lyn

I've already emailed the Specialist Nurses at PCUK and am waiting for a reply . I'll post the relevant info' when I get it. 

From what I've gathered, although oestrogen is used in the treatment of cancers, it can also cause some prostate cancers to grow. I'm not aware of any tests which would give a patient that information. 

I did come across 1 paper which stated that there have been no recorded cases of transgender HRT causing prostate cancer. I guess that only tells us that the research isn't there.

Looking at the endocrinology, not every transgender woman starts on HRT with the expertise of an endocrinologist specialising in transgender health. Transgender women may be managed with post-menopausal levels of hormones, some with pre-menopusal levels as the goal.  Some women will argue that they require supra physiological levels of oestrogen to achieve their desired characteristics. Others still will do things entirely DIY , using online pharmacies and never seeing a specialist. To complicate matters further, whereas drugs such as spironalactone were once prescribed alongside oestrogen, increasingly , there are transgender women who are on cross gender hormones only.
Added to this is the experience that some individuals require much more oestrogen than others to achieve the same blood levels, and that  any given level does not result in a standard level of feminisation.  
And if you thought that wasn't complicated enough, there are the different methods od delivering oestrogen to the body-e.g.  transdermal patches, i.m. and subcutaneous injection at various different body sites, gels, sublingual and oral pills. It is not surprising, given all the various pathways in the body that are governed by hormones, that doctors are risk averse and prescriptions are sometimes at the minimum level possible, rather than any feminisation, the level given is just designed to ward off osteoporosis.

I suppose given the relatively small population of transgender women, and all these variables, it is hardly surprising that there is a lack of good research data.


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