TransMed

THE PROSTATE -- How Necessary Is It?

by Sheila Kirk, M.D.

This begins an occasional series of articles by Dr. Kirk on medical health issues of interest to transgendered people.

All genetic males have a prostate unless it has been removed totally or in part with a surgical procedure. A genetic male not taking feminizing hormones will experience a problem with this accessory sex gland at some time in his life, with few exceptions. With increased sexual activity, the potential for infection increases. With advancing age, complaints due to benign prostate enlargement known as hypertophy are inevitable.

Also with advancing age and with some etiologic factors in occupation, ethnic origin and, life habits virtually all genetic males will encounter prostate cancer. It is the second most common cancer in males next to lung malignancy. At any one time 10 percent of the world's genetic male population has prostate malignancy in some stage of development. It is found as an incidental in 50 percent of autopsied males, in 20 percent of prostate tissue removal in operations for benign disease (that is unsuspected)and if one lives to their eighties, the potential for development of cancer is about 75 percent. All this trouble for a small walnut size gland whose only function is to contribute to the ejaculate, the fluid transporting sperm from the testes, and that contribution is only about 15 percent of the total volume.

Genetic males using an estrogenic regimen are somewhat protected by the medication even if they begin their therapy in mid-life and already have benign Prostatic Hypertrophy developing with some complaints. The gland shrinks on an Estrogen regimen and while no studies exist at present on all benefits to the Transgendered on a feminizing regimen, it is suspected that there may be some protection against prostate malignancy.

Prostate cancer seems to be dependent upon testosterone or other androgenic hormones and part of a treatment regimen to regress the cancer utilizes medications that block testosterone production, its conversion to dehydrotestosterone, or its utilization in body tissues. These drugs are anti-androgens. Estrogen is sometimes a part of that regimen particularly in some cancer treatments because it lowers blood testosterone while it feminizes.

Genetic males who have had genital reassignment surgery do NOT have removal of the prostate as some incorrectly believe. The prostate is not taken out in the operation. With the removal of the testes, the major source of testosterone production is taken away. In those individuals, as in all genetic males using estrogen, the prostate shrinks and becomes smooth. Nodularity which develops with age, becomes less notable. The probability of malignancy in the genetic male who is castrated and/or uses estrogen is likely very small, although no well-controlled studies have been done to really support this view. There have been four medical journal reports of a post-operative male to female transsexuals taking estrogen who developed prostate cancer. Those cancer cases are likely not male hormone dependent malignancies .

What does all of this mean? For the transgendered male not using estrogen, you are headed for all the potentials for prostate disease infection, hypertrophy with urinary complaints and probably malignancy. For the transgendered male who uses estrogen no matter where you are on the continuum you are benefited by your feminization regimen. Your estrogen is lowering your blood testosterone and reducing potential for benign hypertrophy and probably cancer.


© 1996 by Sheila Kirk & TGForum