Trans women and prostate cancer
Do trans women have a prostate?
Yes, trans women have a prostate – the prostate is a gland that sits underneath the bladder and surrounds the urethra, which is the tube that carries urine (wee) out of the body.
The following people have a prostate:
- cis men (men who identify as male and were assigned male at birth)
- trans women (women who identify as female and were assigned male at birth)
- non-binary people who were assigned male at birth
- some intersex people.
The prostate in cis men is usually the size of a walnut but increases in size with age. This increase in size is less if you’re taking feminising hormones (oestrogen) or drugs that prevent androgens like testosterone from having effects on the body (testosterone blockers, also known as anti-androgens).
Having male bits and pieces is not easy – it is a nuisance – but I have always accepted I am a trans woman.
What does the prostate do in trans women?
The prostate’s main job is to help make semen – the fluid that carries sperm.
Trans women who have had genital reconstructive surgery may produce fluid on sexual arousal but won’t produce sperm because the testicles have been removed.
Will my prostate be removed during genital reconstructive surgery?
The prostate is not removed as part of genital reconstructive surgery because of the risk of side effects such as urinary problems and damage to nerves.
The diagram below shows where the prostate is in someone who has had genital reconstructive surgery that includes the formation of a vagina (vaginoplasty).
Where is the prostate in a trans woman after vaginoplasty?
I didn’t know what prostate cancer was. I knew I had a prostate although I wasn’t told about it during transition. I have met many trans women who believe that the prostate is removed with genital reconstructive surgery, but it isn’t.
What non-cancerous prostate problems can trans women get?
Because the prostate is not removed as part of genital reconstructive surgery it can cause the same problems as in cis men. Trans women and non-binary people assigned male at birth can get non-cancerous (benign) problems such as an enlarged prostate or prostatitis – but this is thought to be less likely than in cis men.
Can trans women get prostate cancer?
Yes, trans women and non-binary people assigned male at birth can get prostate cancer.
There aren’t many studies of prostate cancer in trans women but they suggest that there is a lower risk than in cis men.
I’ve always known that people born male have a prostate. It’s something that I have to live with. No health professional raised the risk of prostate problems with me, but I was aware that I was at risk.
If I'm taking hormones or have had genital reconstructive surgery does that mean I won’t get prostate cancer?
No, it doesn’t necessarily mean you won’t get prostate cancer. But the chance of getting it is likely to be lower if you’re taking feminising hormones, testosterone blockers or have had the testicles removed.
Taking feminising hormones, testosterone blockers or having the testicles removed reduces the risk of prostate cancer by lowering testosterone levels. Some researchers believe that trans women who have taken these hormones will only develop prostate cancer if their prostate cancer had started developing before they started transition, but more research is needed.
We don’t know whether the age of starting hormone therapy could be a factor. There is some evidence that being older at transition increases the risk of developing prostate cancer, but we need more research.
What is the risk of prostate cancer in trans women?
We don’t know the exact risk of prostate cancer in trans women.
As in cis men, most cases of prostate cancer in trans women have been in those aged over 50 years.
In cis men, being black or having a family history of prostate cancer increases your risk of getting prostate cancer. Although we don’t have evidence of this in trans women, it’s likely that these things will increase your risk as well.
Although the risk of prostate cancer is likely to be low, it’s important to be aware if you’re a trans woman or a non-binary person assigned male at birth because:
- you might not have any symptoms
- you might be listed as female on your medical records so a health professional may not start a conversation with you about prostate problems
- your PSA levels (used to test if you have prostate problems) are likely to be lower if you are taking feminising hormones so may not be a reliable sign of prostate problems.
If you’re over 50, black or have a family history of prostate cancer you may be at a higher risk of prostate cancer. If you’re worried about your risk of prostate cancer, speak to your GP. They will be able to talk to you about the tests used to diagnose prostate cancer. You can also read more about prostate cancer diagnosis in trans women, including information on tests used, and what to say to health professionals.
What are the symptoms of prostate problems in trans women?
Most early prostate cancer doesn’t usually have any symptoms, but some people might have urinary problems. These can also be a sign of a benign prostate problem, such as an enlarged prostate or prostatitis.
Trans women who have had feminising hormones and therefore have a smaller prostate might be less likely to have symptoms – but if they do have symptoms they might be similar to those of cis men. Read about the possible symptoms of prostate problems in cis men.
Genital reconstructive surgery can cause urinary symptoms and pain so this could be confused with symptoms of prostate problems.
If you have any urinary symptoms as a trans woman or non-binary person assigned male at birth you should speak to your doctor so that they can find out what’s causing them.
Will my prostate get smaller if I am taking hormones to transition?
Your prostate may get smaller if you are taking feminising hormones but you can still get prostate problems.
How does having a prostate affect sex in trans women?
Some trans women who have had vaginoplasty report self-lubrication of the vagina – this may be fluid from the prostate. Not all trans women who have had vaginoplasty experience this. Stimulation of the prostate during vaginal sex can be another source of sexual pleasure.
The prostate gland is sensitive. Stimulation of the prostate gland can be enjoyable for cis men, trans women and non-binary people, for example through anal sex or using fingers or sex toys.
Where can I get more information about the prostate in trans women?
We are currently working on information specifically for trans women on the diagnosis and treatment of prostate problems.
There’s a lot of information on prostate problems on our website. It is mostly based on evidence and guidance for cis men but some of the information will still be relevant if you’re a trans woman or a non-binary person assigned male at birth.
Our services are open to all people with a prostate and those supporting them. For support you can:
- speak to your GP
- contact our Specialist Nurses
- visit our online community for trans women.
Why isn’t there much information about trans women and prostate cancer?
Not many studies have looked at prostate problems in trans women, and those that have are often small. This means that we still don’t know a lot about how prostate problems can affect trans women.
** People who were assigned female at birth and who identify and live as men or women can’t get prostate cancer or prostate disease because they do not have a prostate.
References and reviewers
Updated: October 2020. To be reviewed: October 2023.
- Deebel NA, Morin JP, Autorino R, Vince R, Grob B, Hampton LJ. Prostate Cancer in Transgender Women: Incidence, Etiopathogenesis, and Management Challenges. Urology [Internet]. 2017 Sep [cited 2017 Sep 15]; Available from: http://linkinghub.elsevier.com/retrieve/pii/S0090429517309068
- Ellent E, Matrana MR. Metastatic Prostate Cancer 35 Years After Sex Reassignment Surgery. Clin Genitourin Cancer. 2016 Apr 1;14(2):e207–9.
- Gooren L, Morgentaler A. Prostate cancer incidence in orchidectomised male-to-female transsexual persons treated with oestrogens. Andrologia. 2014 Dec;46(10):1156–60.
- Hembree WC, Cohen-Kettenis P, Waal D de, A H, Gooren LJ, Meyer WJ, et al. Endocrine Treatment of Transsexual Persons:An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009 Sep 1;94(9):3132–54.
- JIN B, TURNER L, WALTERS WAW, HANDELSMAN DJ. Androgen or Estrogen Effects on Human Prostate. M. 2018;6.
- Molokwu CN, Applebaum JS, Miksad RA. Detection of prostate cancer following gender reassignment. BJU Int. 2008;101(2):257–257.
WeyeRS S, SuTTeR PD, HOebeke P, MONSTRey S. Gynaecological aspects of the treatment and follow-up of transsexual men and women. :20.
- James Bellringer, Consultant Gender and Urological Surgeon, Parkside Hospital, London
- Alison May Berner, Specialist Registrar and Clinical Research Fellow in Medical Oncology and Adult Gender Identity, Tavistock and Portman NHS Foundation Trust, London
- Frank Chinegwundoh, Consultant Urological Surgeon, Barts Health NHS Trust
- Jonny Coxon, Speciality Doctor, Gender Identity Clinic, London
- Ben Heyworth, Macmillan Survivorship Network Manager/Honorary Lecturer, The Christie Hospital NHS Foundation Trust/The University of Manchester
- Oliver Hulson, Consultant Radiologist, Leeds Teaching Hospitals NHS Trust
- Sidath Liyanage, Consultant Radiologist, Southend University Hospital, Essex
- Joe O'Sullivan, Consultant Prostate Oncologist, Queen's University Belfast
- Tina Rashid, Consultant in Functional Urology and Genital Reconstruction, Imperial College Healthcare NHS Trust, London
- Vijay K. Sangar, Consultant Urological Surgeon, The Christie NHS Foundation Trust & Manchester University NHS Foundation Trust
- Our Specialist Nurses
- Our Volunteers.
