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Abstract
Klinefelter syndrome (KS), karyotype 47, XXY, is a common cause of hypogonadism in males. Patients with this condition often experience symptoms of gonadal failure, which can precipitate gender identity challenges. Treatment with testosterone replacement therapy (TRT) can combat these symptoms by improving sexual function, muscle mass, bone health, and virilization, thereby enhancing the quality of life (QOL). Although TRT is often employed in patients with KS, there is a concern that the application of exogenous testosterone may increase the risk of prostate adenocarcinoma development and progression. We report the case of a 58-year-old male with KS who is also diagnosed with prostate adenocarcinoma and wished to remain on TRT post-radiation therapy in support of his gender identity and QOL. We describe the challenges this patient faced when balancing a rising prostate-specific antigen level and risk of cancer recurrence with his QOL.
Highlights
Klinefelter syndrome (KS), karyotype 47, XXY, is a common cause of hypogonadism in males [1]
testosterone replacement therapy (TRT) is often employed in patients with KS, there is a concern that the application of exogenous testosterone may increase the risk of prostate adenocarcinoma development and progression [2]
We describe the case of a 58-year-old male with KS who is diagnosed with prostate adenocarcinoma and elects to continue TRT post-radiation therapy in support of his gender identity and quality of life (QOL)
Summary
Klinefelter syndrome (KS), karyotype 47, XXY, is a common cause of hypogonadism in males [1]. During the ensuing discussions regarding prostate cancer treatment, the patient expressed concerns regarding his symptoms of hypogonadism including weight gain and gynecomastia He was counseled by his urologist, radiation oncologist, and endocrinologist about the possible increased risk of cancer progression in the setting of exogenous testosterone administration He felt he was at a turning point with regard to his gender identity and had recently become sexually active, continuing TRT to maintain virilization was important for his QOL. Under the supervision of his treatment team, the patient continues to use TRT variably four years after his initial presentation while adjusting for his PSA levels to optimize his QOL, gender identity, hypogonadism symptoms, and the risk of prostate cancer progression
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