Gender-Affirming Hormone Treatment Does Not Impact Skin Cancer Incidence

The use of gender-affirming hormone therapy (GAHT) does not affect the incidence of skin cancers among transgender patients, according to a recent study.¹

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Researchers cited previous research indicating not only that the incidence of skin cancer is on the rise but that there are sex-dependent differences regarding skin cancer diagnoses, with melanoma and nonmelanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma, being more prevalent in men. They also cited a lack of research discussing the incidence of skin cancers among patients receiving GAHT.

The retrospective cohort study included patients of the Netherlands’ main referral center for individuals experiencing gender dysphoria and incongruence, the Center of Expertise on Gender Dysphoria of the VU University Medical Center Amsterdam, who had visited the center between 1972 and December 2018. All patients had been diagnosed with gender dysphoria by a physician and had received endocrine, psychological, or surgical treatment.

Additionally, researchers obtained data related to skin cancer diagnoses through the Nationwide Network and Registry of Histopathology and Cytopathology in the Netherlands. They obtained data for transgender patients ages 17 and older who had been patients of the aforementioned clinic between 1991 and December 2018.

Patients who had a previous skin cancer diagnosis before being treated at the clinic, had never been on GAHT, or who had alternated between male and female hormones, were excluded from consideration.

As a result of obtaining the data, researchers sorted data into several demographic and disease-specific categories, including age at the induction of GAHT, race, status of gonadectomy, skin cancer diagnosis, pathology diagnosis, Breslow thickness, Clark level I through V, and date of skin cancer diagnosis.

Of the thousands of patient data obtained in the data collection, the study cohort ultimately consisted of 3880 transgender individuals, 2436 of whom were transgender women, and 1444 of whom were transgender men.

Among transgender women in the cohort, there were 8 occurrences of melanoma and 7 of squamous cell carcinoma. 38 cases of nonmelanoma skin cancers were reported, including 7 cases of squamous cell carcinoma, 30 of basal cell carcinoma, and 1 case of skin adnexal carcinoma.

Among transgender men in the cohort, there were 2 occurrences of melanoma and 0 of squamous cell carcinoma. 14 cases of nonmelanoma skin cancers were reported, including 13 cases of basal cell carcinoma and 1 case of Merkel cell carcinoma.

Researchers compared these statistics to the expect number of cases for cisgender men and women, as well as to standardized incidence ratios.

“The results suggest that trans women and trans men using GAHT have a similar risk of skin cancer as the total population,” study authors wrote. “We found no evidence of the GAHT affecting melanoma and SCC development, and our findings do not support a role for sex steroid hormones in skin cancer development in transgender individuals.”

Reference

1. Rahmat A, De Nie I, Wiepjes CM, et al. Skin cancer incidence in transgender individuals receiving gender‐affirming hormone treatment: A nationwide cohort study in the Netherlands. Int J Dermatol. Published online 2023. doi:10.1111/ijd.16707