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El 72 % de quienes usan testosterona refirió dolor pélvico, pero casi todos ya lo tenían antes de empezar

Dolor pélvico en personas transgénero que usan terapia con testosterona

EncuestasHormonas cruzadas
Authors
Sav Zwickl, Laura Burchill, Alex Fang Qi Wong, Shalem Y. Leemaqz, Teddy Cook, Lachlan M. Angus, Kalen Eshin, Charlotte V. Elder, Sonia R. Grover, Jeffrey D. Zajac, Ada S. Cheung
Journal
LGBT Health
Year
2023
Source
https://doi.org/10.1089/lgbt.2022.0187

Summary

Australian doctors said they were seeing more testosterone users with pelvic pain, so they surveyed 486 trans-identified people born female who were taking testosterone. Nearly three-quarters said they had had pelvic pain since starting, usually cramping low in the belly, with a typical severity of 6 out of 10. Pain was more likely in people who still had periods, had PTSD, or had pain during orgasm. Some said the pain disrupted their sex lives. However, almost all of those with pain had also had pelvic pain, mostly period pain, before testosterone, and on average they rated it about the same as before. So the survey cannot show that testosterone causes pelvic pain. It does show that pelvic pain is a common and little-studied problem for this group.

Key findings

  • De 486 usuarios de testosterona encuestados (edad típica de 27 años, unos 2,5 años con testosterona), 351 (72 %) dijeron haber tenido dolor pélvico tras empezar la testosterona.
  • De quienes tenían dolor, el 90 % lo tenía 'a veces' y el 10 % 'siempre o casi siempre'; la gravedad típica era de unos 6 sobre 10, sobre todo calambres en la parte baja del vientre.
  • De quienes tenían dolor con la testosterona, el 98 % también tenía algo de dolor pélvico antes de empezarla, y valoraron el dolor con testosterona aproximadamente igual que antes.
  • El dolor pélvico era unas 4 veces más probable en quienes seguían teniendo la regla, 2,5 veces más probable en quienes tenían TEPT y unas 30 veces más probable en quienes tenían dolor durante el orgasmo.
  • La mitad de quienes tenían dolor dijo que al menos a veces les hacía parar el sexo o cambiar la forma de tenerlo.
  • La mayoría de las 25 o 26 personas a quienes se había extirpado el útero refirió menos dolor después, pero eran demasiado pocas para sacar conclusiones.
  • Los autores sugieren que los problemas con los músculos del suelo pélvico pueden influir y piden investigación sobre las causas y los tratamientos.

Abstract

Purpose: This descriptive study aimed to assess the characteristics of pelvic pain and explore predictive factors for pelvic pain in transgender (trans) individuals using testosterone therapy. Methods: An online cross-sectional survey was open between August 28, 2020, and December 31, 2020, to trans people presumed female at birth, using testosterone for gender affirmation, living in Australia, and >16 years of age. The survey explored characteristics of pelvic pain following initiation of testosterone therapy, type and length of testosterone therapy, menstruation history, and relevant sexual, gynecological, and mental health experiences. Logistic regression was applied to estimate the effect size of possible factors contributing to pain after starting testosterone. Results: Among 486 participants (median age = 27 years), 351 (72.2%)* reported experiencing pelvic pain following initiation of testosterone therapy, described most commonly as in the suprapubic region and as "cramping." Median duration of testosterone therapy was 32 months. Persistent menstruation, current or previous history of post-traumatic stress disorder, and experiences of pain with orgasm were associated with higher odds of pelvic pain after testosterone therapy. No association was observed with genital dryness, intrauterine device use, previous pregnancy, penetrative sexual activities, touching external genitalia, or known diagnoses of endometriosis, vulvodynia, vaginismus, depression, anxiety, or obesity. Conclusions: Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted.

Conclusion

Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted. Until further evidence is available, the authors recommend a tailored, multidisciplinary, trauma-informed approach that may include pain management, sexual function, management of persistent menstruation, and mental health.