性别肯定激素治疗对出生时患有前列腺的跨性别或非二元个体 (TGNB) 的前列腺特异性抗原 (PSA) 和前列腺癌发病率的影响尚不清楚。该队列包括 1024 名自我认定的 TGNB 个体，出生时被指定为男性，接受了治疗退伍军人事务医疗保健系统中的 PSA 测试，按出生年份与顺性别男性进行匹配。使用线性混合效应模型测量 PSA 变化，考虑重复测量和匹配。非促性腺激素释放激素 (GnRH) 激动剂或拮抗剂治疗与 1.30 ng/mL 的 PSA 降低相关（95% 置信区间 [CI]，1.14-1.46与顺性别男性相比，GnRH 治疗与 1.08 ng/mL 的 PSA 降低相关（95% CI，0.60-1.55；P < .001）。在开始激素治疗前后接受 PSA 检测的 450 名 TGNB 个体中，非 GnRH 和 GnRH 治疗导致 0.49 ng/mL 下降（95% CI，0.35-0.62；P < .001）和 0.73 ng/mL 下降(95% CI, 0.43-1.02; P < .001)，分别来自中位基线 0.70 ng/mL。从 50 岁开始，TGNB 前列腺癌发病率为每 1000 患者年 1.79 例，而顺性别男性为每 1000 患者年 4.02 例。性别肯定激素治疗与 PSA 显着降低相关，出生时被指定为男性的 TGNB 个体仍然存在有患前列腺癌的风险。未来的工作应确定在这些情况下是否应使用较低的活检阈值，以及发病率下降是否是由于确定偏倚或激素治疗导致前列腺癌发病率真正下降。版权所有 © 2024 Elsevier Inc. 所有权利预订的。

The effects of gender-affirming hormone therapy on prostate-specific antigen (PSA) and prostate cancer incidence in transgender or nonbinary individuals (TGNB) born with prostate glands remain uncharacterized.The cohort included 1024 self-identified TGNB individuals assigned male at birth who received PSA testing in the Veterans Affairs Healthcare System, matched by birth year to cisgender men. PSA changes were measured using linear-mixed effects modeling accounting for repeated measures and matching.Non-gonadotrophin releasing hormone (GnRH) agonist or antagonist therapy was associated with 1.30 ng/mL lower PSA (95% confidence interval [CI], 1.14-1.46; P < .001) and GnRH therapy was associated with 1.08 ng/mL lower PSA (95% CI, 0.60-1.55; P < .001) compared with cisgender men. Among 450 TGNB individuals who had undergone PSA testing before and after initiation of hormone therapy, non-GnRH and GnRH therapies resulted in 0.49 ng/mL decrease (95% CI, 0.35-0.62; P < .001) and 0.73 ng/mL decrease (95% CI, 0.43-1.02; P < .001), respectively, from a median baseline of 0.70 ng/mL. From time of age 50 years, TGNB prostate cancer incidence was 1.79 per 1000 patient-years versus 4.02 per 1000 patient-years in cisgender men.Gender-affirming hormone therapies are associated with significant decreases in PSA, and TGNB individuals assigned male at birth remain at risk of prostate cancer. Future work should establish if a lower threshold for biopsy should be used in these contexts and if the decreased incidence is a result of ascertainment bias or hormone therapy resulting in a true decrease in the incidence of prostate cancer.Copyright © 2024 Elsevier Inc. All rights reserved.