The Organs You Have: What Gay Men and Trans Women Need to Know About Prostate Health

 

By MetroHealth, Buckeye Flame

If you have a prostate, you need to be screened regularly for prostate cancer starting around age 45—or around age 40 if you are Black or have a family history of prostate cancer. According to the American Cancer Society, having a parent or sibling with prostate cancer more than doubles a person’s risk.

Modern screening for prostate cancer is a PSA test, or prostate-specific antigen test, where a blood sample is analyzed for a specific protein produced by the prostate gland. Sounds simple, right?

Unfortunately, studies show that gay men and transgender women appear to have lower rates of prostate cancer screening. Even if they get screened one time according to recommended guidelines, they’re less likely to be screened regularly, making it difficult to understand fluctuations in the PSA levels that indicate prostate cancer.

And, according to Kirtishri Mishra, MD, a board-certified urologist and the Director of Sexual Health and Gender Reconstructive Surgery at MetroHealth, that’s putting lives at risk.

“Prostate cancer screening saves lives,” says Dr. Mishra. “Prostate cancer is incredibly treatable if you pick up the disease early. But if the cancer spreads outside of the prostate, it can be deadly.”

Breaking Barriers

So, if prostate cancer screening is a simple blood test and prostate cancer is easily treatable in early stages, why don’t more gay men and trans women get screened?

To Dr. Mishra, the problem is two-fold. First, healthcare disparities—including access to care and discrimination—are more common for members of the LGBTQ+ community. And because the disease disproportionately impacts Black men, it’s not uncommon for gay Black men and Black trans women to face additional disparities.

“It’s on us as providers,” says Dr. Mishra. “Many providers aren’t comfortable talking about these issues with LGBTQ+ patients.”

That’s why Dr. Mishra has been on a personal journey to improve his knowledge about LGBTQ+ health issues. While he’s been at the forefront of gender-affirming surgery, a recent teleconference caused him to reflect on how he can improve.

“They were telling a story about the partner of a gay man who was in the room when a prostate cancer diagnosis was explained, and the provider wouldn’t look at the partner—only the patient—and didn’t discuss the sexual side effects and prognosis,” recalls Dr. Mishra. “I realized that I was guilty of doing that sometimes, too. I had to reflect on my own practice and proactively work towards eliminating bias.”

Secondly, he wants the field of urology to improve.

“My ask of my urology colleagues is to have sexuality and gender baked into cancer care,” says Dr. Mishra. “Let’s offer the same benefits to LGBTQ+ patients as we do to straight and cisgender patients.”

Understanding Prostate Cancer Treatment Within Gender/Sexuality Contexts

For those with a prostate, treating prostate cancer has the same side effects for gay men and trans women as it does for straight, cisgender men.

Surgical treatment often has immediate drawbacks that can improve over time. Incontinence and erectile dysfunction are common in the six weeks that follow surgery.

Meanwhile, radiation treatment may not produce immediate side effects, but one to two years later, incontinence and erectile dysfunction can occur. However, one immediate side effect of radiation treatment is often proctitis, or inflammation of the rectum’s lining. It can cause fecal incontinence and irritation.

While the side effects are universal, the cultural contexts are vastly different. Sexual health is incredibly important to the identities of gay men. Erectile dysfunction— both as someone who performs and receives penetrative anal intercourse—isn’t just about sexual performance, it’s about identity. If one partner is unable to perform due to treatment, it can create guilt and resentment, feeling like one partner is a “prisoner” to another’s disease.

That’s why, according to Dr. Mishra, patients can’t be looked at in a cold, clinical light. They have to be seen for who they are.

“The conversation about treatment with gay men and their partners must include intimacy and their sexual life,” says Dr. Mishra. “We talk about what sexual activities are a part of their life, how each intervention might impact those activities and ways to preserve intimacy in their relationships. The discussion must empower patients to understand the pros and cons of each treatment.”

Sexual Health is Health

Helping LGBTQ+ patients who have a prostate understand the impact of treatment on their sexual lives—and work to improve their sexual lives during a diagnosis—is critical to survivorship.

That’s why MetroHealth launched a new rehabilitation program aimed at helping all patients with a prostate cancer diagnosis have the healthiest sexual health outcome possible.

Patients meet with a sexual health expert before treatment. The provider understands the level of erectile dysfunction prior to surgery and may start patients on medication to improve blood flow to the groin. Continuing the medication after surgery allows for improved healing. Other therapies within the clinic include pelvic floor physical therapy before and after treatment to reduce urinary incontinence.

Prostate Cancer and Trans Women: Still At Risk

Dr. Mishra isn’t surprised anymore when he receives a call from a primary care doctor asking this question: “Does she still have a prostate? I don’t see it on the X-ray.”

“Gender-affirming surgery is still an area where some providers don’t have all of the details,” says Dr. Mishra. “There’s a poor understanding among providers regarding the anatomical arrangement of a person’s pelvic area after gender-affirming surgery.”

During a vaginoplasty, the prostate is not removed. Removing the prostate can cause incontinence and poor sexual function in trans women, plus, the prostate has many erogenous nerves that provide sexual pleasure.

And even though gender-affirming hormone therapy often shrinks the prostate, trans women are still at risk for prostate cancer, much more than previously thought. Mishra knows. He did the research.

“There’s still much to discover about the risk of prostate cancer after gender-affirming surgery and hormone therapy,” says Mishra. “But research I contributed to in 2024 shows that prostate cancer isn’t rare at all in transgender women, despite previous thinking.”

The message for trans women is clear: find a culturally competent provider and get screened for prostate cancer.

“Unfortunately, people in the LGBTQ+ population encounter providers who aren’t comfortable talking about these issues, let alone treating them,” says Mishra. “That’s why we’re fortunate at MetroHealth to have the MetroHealth Pride Network. Cultural competency is critical.”

About The MetroHealth Pride Network

The MetroHealth Pride Network offers primary and mental healthcare for adults and children and gender-affirming care for adults. While people in the LGBTQ+ community have similar routine healthcare needs as cisgender or heterosexual people, providers in the MetroHealth Pride Network have specialized training and experience related to sexuality and gender.

Pride Network providers can be found in five MetroHealth locations—Brecksville, Brooklyn, Cleveland Heights, Parma and Rocky River as well as a clinic in the LGBT Community Center of Greater Cleveland. Learn more at www.metrohealth.org/pride.

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The Buckeye Flame is an online platform dedicated to amplifying the voices of LGBTQ+ Ohioans to support community and civic empowerment through the creation of engaging content that chronicles their triumphs, struggles, and lived experiences.

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Photo: thebuckeyeflame

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