Hormone-related tumors in transsexuals receiving treatment with cross-sex hormones

Abstract

Objective: To assess the risk of development of hormone-related tumors in transsexuals receiving treatment with cross-sex hormones. Design: Description of cases of transsexuals who have developed a hormone-related malignancy observed in their own clinic or reported in the literature. Recommendations for early diagnosis and prevention are presented. Methods: Review of the literature in PubMed. Results: In male-to-female transsexuals receiving estrogen administration, lactotroph adenomas, breast cancer, and prostate cancer have been reported. In female-to-male transsexuals receiving treatment with testosterone, a single case of breast carcinoma and several cases of ovarian cancer have been reported. So far endometrial cancer has not been encountered though it remains a potential malignant development. Conclusions: There are so far only a few cases of hormone-related cancer in transsexuals. There may be an underreporting. The probability of a hormone-related tumor increases with the duration of exposure to cross-sex hormones and the aging of the population of transsexuals.

Cancer in Transgender People: Evidence and Methodological Considerations

“…Whereas cancer among transgender people is listed among research priorities (10), most of the concerns pertaining to the occurrence and outcomes of malignant tumors in this population are based on anecdotal evidence or on the general considerations of possible disease mechanisms (13)(14)(15)(16)(17)(18). The high quality empirical data assessing cancer incidence and mortality among transgender people are lacking primarily because of an absence of large-scale prospective studies of this population (19).…”

Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case–control study

“…Cancer has not been reported frequently in trans individuals (2,14). However, because some tumors are hormone dependent, examining the incidence of cancer during cross-sex hormone therapy may be important (15).…”

The primary health care of transgender adults

“…53 Histology of specimens from mastectomies in a transmen show changes consistent with postmenopausal involution, and replacement of glandular structures. [53][54][55] As described above, ongoing oestradiol production occurs in transgender men, making oestrogen-mediated carcinogenesis a theoretical possibility. Most studies of low-dose testosterone in postmenopausal ciswomen show no effect on breast cancer risk.…”

“…Chest surgery among ciswomen reduces risk in proportion to amount of tissues removed. 56 Retrospective and case-control studies suggest the risk is comparable to cisgender men, 28,54 but there are no long-term prospective studies. As some breast tissue remains after surgery, yearly chest wall examination is recommended.…”