My cancer scare: 46XX and born with a prostate!

I have had pain with urinating for several years now, problems emptying my bladder, and outright bladder cramping due to spasms. These problems were happening even when I lived as an intersex woman. Now appearing and living as a man, the pain recently became so bad I was finally driven, by sheer desperation, to answers.

Due to being assigned female in error, instead of my body recognized by the medical community as being born intersex, few doctors were paying attention to something potentially very serious. You see- similar to a trans man, I was assigned a girl in error due to being 46XX and having obvious ovaries, a uterus, and a vagina. What most of my doctors missed is that along with my intersex phallus; I have a prostate! 

Just like any person who has a prostate, it needs to be monitored and acknowledged for its existence. A doctor knowing if a person has a prostate is even more critical if it is causing pain. For a lifetime now, it was my suspicion that since I ejaculate I had a prostate. Recently with orgasm and ejaculation, the pain and spasms were by far worse. However, living as a woman, no doctor would take me seriously. Now that I appear a man, they finally started doing PSA testing for several years. To our surprise, it came back elevated, which can mean cancer! 

My cancer scare and pain were very alarming, so my gynecologist and urologist sent me in for a CatScan, MRI, and a cystoscope. There it was, my prostate showing imflamation. Living as a man now, I have to say it was very validating to know that I have a prostate. I searched, doubting I was the first, and there it was: a 46XX man with prostate cancer. The scare was real that I could make history in this horrible way along with this anonymous intersex man in this medical journal.  Note: the medical journal on this 46XX man with prostate cancer is below. Never the less, I was put on a round of antibiotics, Uribel and Tamsulosin, to help with emptying my bladder. Thanks to medical intervention, the pain is better managed now. Thankfully after my doctor’s thoughtful screening, it was not cancer. Thank goodness!  

Before I move on with my blog, I will answer two important questions below so that no one is confused about PSA testing and how a 46XX person can develope a prostate.

What is a PSA test?

The PSA test is a blood test that measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells. It is normal to have a small amount of PSA in your blood, and the amount rises as a person gets older and as your prostate grows larger. An elevated PSA level may suggest you have a problem with your prostate, but not necessarily cancer. 

How can a 46XX person have a prostate?

Typically a person who is 46XX develops with typical endosex female appearing genitals and a female reproductive system. Thus, due to societal norms most of us live the life of a woman. Due to being born intersex, it ended up that when my 46XX fetus developed, I did not develop endosex. Instead, my body developed in between as an intersex person who felt like a boy, being raised a girl.

We used to be called hermaphrodites, and my diagnosis is Q56.0 Hermaphroditism. My body’s virilization (masculinization) was due to my adrenals and ovaries creating a higher androgen/testosterone level that turned on genes which masculinized my reproductive system and genitals. Below, I educate these intersex differences with the prader scale. This prader scale shows some of the bodily variations that can occur between endosex female and endosex male for some intersex bodily variations. You are born endosex if you are not intersex.

One of the things the Prader scale does is not show is that there can be prostate development, not just the development of a clitoral megally or the development of a phallus/penis. During typical fetal in-utero development in that same spot, an endosex female will develop a skeen gland (also known as the female prostate). A typical endosex male will grow a normal prostate. With some intersex variations, that same spot on a fetus will develop in-between or become a full prostate. Similarly, the genital tubercle on a fetus will grow into a clitoris or penis. Yet, as you can see above, with some intersex bodily variations, that genital tubercle will develop into something in-between the two.

It is not just Endosex, Cisgender Men who can have a prostrate.

Nevertheless, if born with a prostate, we can have some of the same medical issues that an endosex cisgender male/man could have. Let it also be known that the development of a prostate or prostate tissue can happen due to testosterone’s long-term exposure on most any human person. It is also known that prostate development can happen to any fetus or adult, who has long-term testosterone exposure. Therefore if the medical complex assumes that endosex cisgender males who identify as men are the only ones screened for prostate problems, they have now missed millions of people who have a prostate who do not identify as men. 

Statistics show that 1.7% to 2% of the world’s population is born intersex. This means intersex variations are as common as people with red hair. If we add to this the number of transgender women, trans masculine, and transgender men, we now have hundreds of millions of people who potentially have a prostate that the medical complex may be missing.   Note my reference below show that trans women and even trans men or transmasculine people can have a prostate or prostate tissue.

This list below shows the different types of human that may have a prostate, which means an annual screening with PSA is warranted. If they are like me in pain, doctors also need to know that this organ exists, and it needs to be taken into consideration even if the person appears as a woman or feminine. At this time, endosex, cisgender men are under consideration unless you bring it up yourself that you have prostate or have a doctor that knows what you just read here.

1. 46XY Endosex males who live as men
2. 46XY Transgender Women regardless of sex change operations, since the prostate is part of the urinary system, not the reproductive system.
3. 46XX Intersex woman and intersex men who can develop a prostate in-utero.
4. 46XX Trans men or Transmasculine people who are on testosterone and can grow one.
5. Other intersex bodily or chromosomal variations that may have developed a prostate.

Most urologists and primary care physicians recommend that screening happens once a year for people who have a prostate. Note: I am not a doctor, just an intersex survivor, and educator, so please inquire with your doctor. If you run into problems, you might need to find an LGBTQIA+ safe doctor.

My new meds for my prostate claim to only be for men: this is a problem.

My medication’s information insert states: “Men use tamsulosin to treat the symptoms of an enlarged prostate (Benign prostatic hyperplasia- BPH.” I lived as a woman for the first forty-six years of my life. I had had symptoms of this problem when I was living as a woman. It finally got diagnosed with me living as a man. As a woman, I would not have wanted my prostrate referred to as belonging to a man. I will assume that intersex and transgender women or nonbinary people with a prostate would not like the useage of the word “men” any better. An easy solution would be to refer to all of us as “people with a prostate” take this drug for symptoms of an enlarged prostate. There, the problem was solved.

There is so much work to be done! I hope this blog brings to light some of the cultural problems we face when looking into the eyes of cultural dysphoria. I use the word “cultural dysphoria” to explain when society erases our intersex, trans, and nonbinary existence by looking at things through a binary endosex cisgender lens only. With this binary-only lens, the medical complex does much harm, shoving all of us into pink and blue only options regardless of our sex traits a person might have—this denial of our existence, no doubt, costing lives.

Like I keep saying: I am not in the wrong body, but I sure feel like I am on the wrong planet. 

We exist! We are real! We are human! 

References:

1. Trans men and transmasculine people on testosterone can grow prostate tissue Posted on October 31, 2020 by Zinnia Jones
2. A Patient (46XX) With Congenital Adrenal Hyperplasia and Prostate Cancer: A Case Report | NCBI, PMC: J Endocr Soc. 2017 Sep 1; 1(9): 1213–1216. Published online 2017 Aug 17.
3. Trans women and prostate cancer | By Prostate Cancer United Kingdom
4. Skene’s gland | Wikipedia

My related blogs: 

1. Eight Names for the SAME thing: Penis, Phallus, Clitoris, Phalloclitoris, Micropenis, Microphalus, Clitoromegaly and Pseudo-Penis.
2. Cultural Dysphoria: Stop conflating anatomical sex with gender identity.
3. Why was I diagnosed with GENDER DYSPHORIA?
4. I am Proudly the First in Colorado to get an Intersex Birth Certificate

~.V.~