Figure 1 Differences in bladder cancer between genders Figure 1 | Differences in bladder cancer between genders. Men have a threefold greater risk of being diagnosed with bladder cancer than women and are diagnosed at a relatively younger age (62 years versus 67 years). Reproductive factors, such as age at menarche, oral contraceptive use, parity, age at first childbirth, age at menopause, hysterectomy and hormone replacement therapy affect bladder cancer development in women. Women are diagnosed at an older age, with higher grade and higher stage tumours than men and have a worse prognosis. Behavioural factors, such as smoking, increase the risk of disease recurrence and adversely affects response to some treatments. Sex steroid hormones and their receptors, which are differentially expressed in men and women, could affect disease progression. Testosterone has been shown to promote tumorigenesis and ADT has been postulated as a potential treatment. Oestrogen seems to be protective against bladder cancer in the general population but has been shown to promote cancer in affected individuals. Abbreviations: ADT, androgen deprivation therapy; HRT, hormone replacement therapy; NMIBC, non-muscle-invasive bladder cancer. Lucca, I. et al. (2015) Gender differences in incidence and outcomes of urothelial and kidney cancer Nat. Rev. Urol. doi:10.1038/nrurol.2015.232