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Breast Tissues in Transsexual Women–A Nonprostatic Source of Androgen Up-Regulated Production of Prostate-Specific Antigen

Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Kent Ridge, Singapore 110794

Address all correspondence and requests for reprints to: Victor Goh, Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Kent Ridge, Singapore 110794; E-mail: obggohhh{at}nus.edu.sg

The present study made use of the female transsexual model and sought to evaluate the contributions of the ovarian, endometrial, and breast tissues to the androgen up-regulated production of prostate specific antigen (PSA). Serum levels of PSA were significantly raised in female transsexuals before surgery, after long-term androgen therapy (mean ± SE = 35.3 ± 6.2 pg/mL) when compared with female transsexuals before surgery, but with no androgen therapy (mean ± SE = 1.53 ± 0.25 pg/mL). In addition, in androngenized female transsexuals, after surgery, concentrations of PSA (mean ± SE = 14.5 ± 2.8 pg/mL) were significantly lowered compared with androngenized female transsexuals after surgery, but the levels were, nevertheless, significantly higher than in normal females. Monthly im injection of 250 mg Sustanon-250 to female transsexuals had raised serum testosterone levels to within the male range. In five subjects, in whom serial measurements were taken, serum testosterone levels were greatly raised 24 h after the testosterone therapy; the mean level (±SE) was 19.5 ± 2.1 ng/mL. But in spite of these high testosterone levels, serum PSA levels (mean ± SE = 2.2 ± 0.9 pg/mL) were not significantly raised. However, after 12 months of androgen therapy, the mean (±SE) PSA level in these five subjects was 47 ± 11.6 pg/mL and was significantly higher than the mean level in nonandrogenized female transsexuals. The present study confirmed that high levels of testosterone were able to up-regulate PSA production in women. This up-regulation of PSA production is both a dose- and time-dependent process. Furthermore, the evidence indicates that breast tissues are possibly a nonprostatic source of androgen up-regulated production of PSA women.

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