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Symptoms and PSA results in post-operative transsexual women

Posted 21 Mar 2017 at 12:22


I underwent reassignment surgery in 1990 (am now aged almost 71). Full surgery though prostate not removed. Have been on oestrogen since 1987. I now have symptoms which could be suggestive of prostate cancer: discomfort, difficulty in starting/stopping urine, feeling of bladder not emptying, etc. My father had prostate cancer at a relatively early age.

I'm now awaiting PSA blood test results. However, living in the west of Ireland I have little confidence that a specialist will have had ANY experience of post-op transsexuals and PSA results. I've read (Prostrate Canada) that in post-operative transsexual women a PSA result of >1.0ng/mL should be regarded as significant, whereas it would in males be regarded as normal, but I'm no professional and I may well be misinterpreting things.

I'd just be interested to learn whether there are others who have had similar symptoms after many years of reassignment surgery, and of people's experience with PSA blood test results under these circumstances.

Thanks a million



PS.  Many thanks to those who replied to me already. The administrator (Carol) emailed me suggesting that I re-post, and she said that she has changed my name (as many of you kindly advised). I gather that Carol hid my original post in order to protect me from trolls, etc; and thanks so much to others who suggested the same thing, and indeed for all your kind words and advice, which I'll follow up on.  H.

Posted 21 Mar 2017 at 12:42

PPS. To those who replied to my original posting (now hidden): I would be very grateful if you could re-post any suggestions, as I now can't see what you wrote previously. The reason for this is that Carol kindly hid that conversation to protect me, and my email address is now hidden and my identity is now heather.c

Thanks and regards


Posted 21 Mar 2017 at 15:24

My short answer to you is - I don't know how your change of gender might affect things . . . . that said, I do know that when I was going through the process of discussing the options of radiotherapy or surgery, I was told that the radiotherapy option started with a course of 'hormone therapy.' As I took the surgical option I didn't pursue the details of the hormones in that 'hormone therapy' but my understanding was that they were hormones which supressed the production of testosterone. I was told that taking these hormones stopped the progress of the disease and shrunk the prostrate prior to it being targeted by the radiotherapy. So what . . . . it may be that you have been taking these hormones and it may be that has an impact of your PSA results? That is a question your urologist should be able to answer.

Posted 22 Mar 2017 at 09:50

One other thing I can add . . . . the PSA result is very much a starting point and if it's anything over a very small number they will recommend a biopsy. The bizarre thing about the PSA number is that you can have a PSA count as low as 3 and still have prostate cancer and you can have a PSA count at over 100 and not have prostate cancer. The PSA test is cheap and simple blunt instrument but it is a cheap and simple starting point.

Posted 22 Mar 2017 at 12:11

Also wanted to say that the symptoms you are describing do not necessarily mean prostate cancer, prostatitis or BPH can also cause those symptoms. Whilst my husband was diagnosed with PCa his surgeon is convinced that it was prostatitis causing the symptoms and not the cancer itself.

Posted 26 Mar 2017 at 13:09

Good morning

This is my understanding of things, having been in a related situation ( I had a prostatectomy for cancer, then began HRT, but have not yet undergone any gender reassignment surgery):

An orchidectomy and oestrogen administration can reduce the volume of the prostate. Non cancerous enlargement of the prostate, common in men over 50, can cause some of the symptoms you describe. But the severity of the symptoms are not always in proportion to the degree of enlargement. I interpret this to suggest that age related prostatic changes can still occur irrespective of hormone profile. So, you may not have a grossly enlarged prostate, by virtue of oestrogen, but still have obstruction issues.

Conjecture on my part, but I imagine that a prostate from a person who has  oestrogen therapy and a bilateral orchidectomy will be fibrosed. After all, it is widely reported that the (nature and ) volume of prostatic secretions is much reduced in this scenario.  I suppose an MRI scan of it would need careful interpretation because it may look unusual purely from that starting point . But I don't think that anyone is trained to interpret post gender reassignment surgery prostates. All the scientific literature says, is that there is no evidence- but that 's beacuse there are no studies. But MRI is routinely used to diagnose and plan prostatectomy surgery. 

A smaller prostate , likely because of gender reassignment, should make it more likely that any biopsy will pick up any tumour cells. But , as always, there are false positives and negatives.

Some prostate cancers are 'fed' by oestrogen. I was concerned about this, and asked my consultant about this before chosing to begin oestrogen for gender dysphoria. Unfortunately he didn't have any guidance. I found some research that suggested for those oestrogen dependent prostate cancers, PSA readings may be unreliable. There appears to be no routinely applied test for checking if this is relevant to an individual. When I asked if my tissues samples could be used to check, i was told not.

I've just re read what I've typed. Prostate cancer detection is enough of a lottery in pre reassignment surgery, pre HRT individuals. For trans- women, it is even more so. In your situation, I guess that's an added incentive to be assertive in any prostate related healthcare appointments you may have.  I don't say that to create alarm. More to say that you will have to become your own expert. Try a 1:1 chat with the Specialist Nurses on PCUK to get you started. 

Good luck, Heather. 

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