![]() Because estrogen, which lowers testosterone and suppresses prostate cancer, 3 was the most common feminization therapy, patients were grouped by never used estrogen, formerly used estrogen but stopped prior to prostate cancer diagnosis, or actively used estrogen at diagnosis. Data at diagnosis were collected, including gender-affirming hormone therapies used, prostate-specific antigen (PSA), PSA density (measure of prostate cancer aggressiveness ), bilateral orchiectomy status, biopsy grade group (grades 1-5, with 5 being most severe), and clinical stage (T1-T4, with T4 being most advanced eMethods in Supplement 1). 2 Data from community clinicians were included if available in VA notes. The number of cases per year was approximated using previous estimates of the median year of transgender identity entry in VA records (2011), corresponding to approximately 11 years of follow-up (2011-2022). ![]() ![]() Detailed chart review was performed to confirm transgender identity and prostate cancer diagnosis. After Durham VA institutional review board approval with a waiver of informed consent, VA records for all adults with an International Classification of Diseases code for prostate cancer and at least 1 code for transgender identity at any time from January 2000 to November 2022 were queried. ![]()
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