Health-care disparities contribute to delayed testicular cancer diagnosis in a transgender woman
New Rochelle, NY, February 4, 2016–A family physician reports the case of a transgender woman whose testosterone levels rose unexpectedly while on feminizing hormones, leading eventually to a diagnosis of a rare, virilizing form of testicular cancer. The complex medical and psychosocial factors related to the care of transgender patients that contributed to the delay in diagnosis are examined in the study published in LGBT Health, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is part of a new Special Issue on LGBT Populations and Cancer and is available free to download on the LGBT Health website.
In "A Transgender Woman with Testicular Cancer: A New Twist on an Old Problem," Carolyn Wolf-Gould, MD and Christopher Wolf-Gould, MD, A.O. Fox Memorial Hospital, Oneonta, NY, provide a detailed account of the 28-year-old transgender woman's care, beginning when she requested feminizing hormone therapy from a family physician who was relatively new to the care of transgender patients. Despite initiation of appropriate testosterone-blocking and feminizing hormone therapy, and no evidence of a testicular mass at the initiation of treatment and 13-month follow-up, the patient's testosterone levels began to rise and continued to do so. She denied the presence of a testicular mass; however, a cancerous mass was discovered on examination at her 24-month visit.
Drs. Wolf-Gould detail the factors that contributed to the delay in detection of the cancer. These included a failed attempt to access insurance coverage for vaginoplasty and the patient's emotional response to this setback, transportation and distance challenges that caused her to miss appointments, and anatomical dysphoria– the patient's reluctance to examine her testes despite awareness of change within her scrotum. This case underscores the need to remove barriers to care for transgender patients, develop better evidence-based treatment guidelines, and create venues for medical providers to learn appropriate biopsychosocial care for this underserved population. The authors discuss screening recommendations for patients whose anatomy does not match their gender identity.
"This case illustrates the complexity of attending to the biopsychosocial needs of transgender patients due to numerous barriers to care including the scarcity of resources for case consultations and provider education," says LGBT Health Editor-in-Chief William Byne, MD, PhD, James J Peters VA Medical Center, Bronx, NY, and Icahn School of Medicine at Mount Sinai, New York, NY.
About the Journal
LGBT Health, published bimonthly online with Open Access options and in print, brings together the LGBT research, health care, and advocacy communities to address current challenges and improve the health, well-being, and clinical outcomes of LGBT persons. Spanning a broad array of disciplines, the Journal publishes peer-reviewed original research, review articles, clinical reports, case studies, legal and policy perspectives, and much more. Complete tables of content and a sample issue may be viewed on the LGBT Health website.
About the Publisher
Mary Ann Liebert, Inc., publishers is a privately held, fully integrated media company known for establishing authoritative medical and biomedical peer-reviewed journals, including Transgender Health, AIDS Patient Care and STDs, AIDS Research and Human Retroviruses, Journal of Women's Health, and Population Health Management. Its biotechnology trade magazine, Genetic Engineering & Biotechnology News (GEN), was the first in its field and is today the industry's most widely read publication worldwide. A complete list of the firm's more than 80 journals, newsmagazines, and books is available on the Mary Ann Liebert, Inc., publishers website.