Distribution of PSA Values and Frequency of Very Low PSA Among Transfeminine Individuals and Referent Cis-Gender Males Open Access

Abstract

Introduction: Whereas hormone and surgical gender affirmation in transfeminine patients result in profound anatomic and endocrine changes, the prostate usually remains intact. It is not clear if levels of prostate specific antigen (PSA), an important marker of prostate cancer and its aggressiveness, differ in transfeminine people compared to cis-gender men. This was investigated by analyzing clinical data from the Study of Transition, Outcome and Gender (STRONG).

Methods: The current data analyses are limited to transfeminine subjects and cis-gender male controls who were fifty years of age or older, had no history of cancer at baseline, and had at least one PSA test during follow up. All PSA test results were averaged for each participant. The overall distributions of the PSA levels among transfeminine cohort members and their referents were compared using Mann-Whitney test. In addition, the prevalence of low (<0.5 ng/ml) average PSA was compared across the two study groups by multivariable log binomial regression model, which controlled for age, race and frequency of PSA testing.

Results: The eligible study participants included 775 transfeminine cohort members and 9,360 matched subjects. Transfeminine cohort members had significantly lower PSA levels compared to their matched referents (Mann-Whitney p-value <0.001). The multivariable log-binomial model demonstrated that the prevalence of low (<0.5 ng/ml) blood PSA was significantly higher in transfeminine study participants compared with cisgender males (Prevalence ratio = 3.17, 95% confidence interval: 2.92–3.45) after adjusting for other factors.

 

Conclusions: To the best of our knowledge, this study is the first to compare the distributions of PSA levels among transfeminine people to the corresponding distributions in cis-gender men. These data can be viewed as the initial step towards much needed standardization of laboratory norms for transgender patients.

Table of Contents

Introduction …………………………………………………………………………….. 1

Methods …………………………………………………………………………………. 4

Results …………………………………………………………………………………... 6

Discussion ………………………………………………………………………………. 7

References ………………………………………………………………………………. 9

Tables and Figures ……………………………………………………………………. 10

Table 1 ……………………………………………………………………………......... 10

Table 2 …………………………………………………………………….………….... 10

Figure 1 ………………………………………………………………………………... 11

Table 3 …………………………………………………………………………………. 11 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Oncology Health Sciences, Epidemiology
Keyword	Cisgender PSA Prostate cancer Transgender Transfeminine Hormonal replacement therapy HRT Prevelance
Committee Chair / Thesis Advisor	Goodman, Michael, Emory University

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