When a Woman Has a Prostate

naomiI feel a lot of prostates; it’s part of my job. And yes, a fair number of my patients are women with prostates and men with vaginas. In fact, the majority of transgender people have not had any gender-affirming surgery. It is therefore not uncommon for a woman to have a prostate, penis and scrotum, or for a man to have a vagina, uterus and ovaries.

Breasts may be reduced or augmented, depending on the desired outcome. It is important that the individual and their organs receive the health care needed, regardless of the individual’s chosen gender. Prostates need to be palpated, cervixes need pap smears, breasts need exams and mammograms, and problems such as prostate enlargement, unusual bleeding from the vagina, sores on any organ or discharge from any orifice need to be worked up.

For those who have had surgery, the alterations need to be monitored to keep those individuals healthy. Urinary tract infections are common in MTF, and a constructed vagina may need regular dilation or intercourse. In FTM, the vagina may atrophy, if present, and this can cause varying degrees of discomfort.

While surgery is uncommon, most transgender people do take hormones to affirm their gender. Hormones can cause a large array of health care problems including blood clots, gallstones, elevated liver enzymes, and high cholesterol in MTF taking feminizing hormones. Or, in FTM taking masculinizing hormones, there may be increased red blood cell count, sleep apnea, weight gain, and elevated liver enzymes or hyperlipidemia. All individuals on hormones should be regularly monitored for appropriate therapeutic levels, and screened for risk factors associated with hormonal therapy.

Patients can be reluctant to discuss health care issues involving body parts that are not part of their gender identity, and may not ask for pertinent health care evaluations. As many as 45% do not even inform their primary care providers that they are transgender. We live in a binary gender society, and most medical forms reflect this. Providers may only see “male or female” and may not ask. But this is not a good time for “don’t ask don’t tell.” Because of negative experiences with health care services, one third of transgender people have delayed, or not received, needed health care procedures. Others have been refused services by providers or insurance.

We are lucky in the Bay Area to have many excellent providers and centers of care for the Transgender community. To mention a few:

Lyon-Martin provides services regardless of ability to pay.

The Asian Pacific Islander Wellness center provides weekly free comprehensive medical care.

At the Department of Public Health’s Tom Waddell clinic, there is a weekly transgender clinic.

Dimensions is a twice-weekly clinic within the Castro-Mission Health Center offering low-cost services for transgender youth aged 12 to 25.

The Center of Excellence for Transgender healthcare at UCSF provides clinician education and access to comprehensive services throughout UCSF.

Medi-cal expansion, thanks to Obamacare, now provides healthcare for many formerly uninsured transgender people.

Has it been a while since you, your prostate or breasts were evaluated? Consider your options! If you know of a clinic or organization that serves our transgender community with distinction, please send in a letter and let us know!

Dr. Naomi Jay is a nurse practitioner in the department of Infectious Disease at UCSF.