Medical gender affirmation is a multi-step process that combines long-term hormone therapy with surgical procedures to conform the sex-related phenotype and gender identity in individuals with gender dysphoria. The clinical aspects of sex reassignment are rapidly advancing, with very satisfying appearance results and decreasing physical side-effects. However, the long-term consequences of continuously high levels of sex hormones on cancer risk and treatment are explored to a very little extent.
We at ICPI have placed primary, secondary and tertiary cancer prevention in transgender individuals among one of our top priorities. We will pursue this objective through an interdisciplinary and international network of clinicians, epidemiologists and basic scientists to develop two main programs.
I. Transgender Cancer Prevention advance studies:
Advancing education, is one of the corner stones of ICPI. We will develop educational programs (Advanced Master Program, Periodic courses, social outreach) to implement cancer research and cancer prevention at both experimental and clinical level in the gender affirmation procedure and transgender health care. The advanced master program will be aimed at physicians of all the four branches, psychiatrists, endocrinologists, general practitioners and plastic surgeons; the outreach will be aimed at the transgender individuals and their families.
II. Sex hormones and cancer research projects:
We will initiate a research fellowship program to promote research on the effect of long-term exposure to sex hormones, at doses used in medial sex affirmation, at the individualised level. These projects will include: i) studying the susceptibility of target cells and tissues to hormone therapy at the genetic and epigenetic levels. We will be particularly focusing on mammary epithelium (knowing that male breast cancer can be particularly aggressive) and on the skin, specifically on melanoma and squamous cell carcinomas, knowing that both of these are under sex hormone control.
Cross-sex hormone therapy – un answered questions
At ICPI, we aim to bridge the gap between scientific society involved in the research on the role of sex hormones in cancer development on one side, and the clinical practitioners who prescribe these hormones in different physiological or pathophysiological conditions and also the individuals who receive these hormones on the other side. Through our vast network of collaborators, we will provide the outcome of clinical and basic research focusing on sex hormones and cancer incidence and also prevention. Our membership program provides a direct link, through which the members of ICPI can interact with us and ask their questions and concerns with regards to sex hormones and cancer.
We believe that the most important questions in the field of medical gender reaffirmation and cross-sex hormone therapy are remained un-answered. Our goal is to lead concerted multi-center research to address these questions of important clinical significance in order to determine a spectrum of therapeutic protocols with cross sex hormones that ensure the highest safety with regards to the risk of cancer development.
A few of the most urgent issues to be addressed are the following
- Does cross-sex hormone intake increase the risk of breast cancer in the trans-female or trans-female individuals? Are there any risks of cancers in non-reproductive organs?
- What kind of screening and monitoring tests are needed with regards to cancer prevention during hormone-intake?
- Is the cross-sex hormone therapy safe in individuals with a history of primary cancer or with a familial history of cancer? In there any risk for the development of another type of cancer?
- What is the best therapeutic protocol for cross-sex hormone therapy considering the cancer risk?
- What end points should be considered in the decision-making process to design the cross-sex hormone therapy protocols on an individualized level?
- Is it necessary to remove the reproductive organs to minimize the risk of cancer development when under cross-sex hormone therapy?