Summary

Using a large US online study of LGBTQ+ adults, a Stanford and UCSF team looked at long-lasting pelvic pain (at least three months) in 2,579 trans men and nonbinary people born female. About one in five had it, similar to estimates for women in general. It often came with bowel conditions, PCOS (a hormone condition affecting the ovaries), fibroids and severe mental-health problems. Current testosterone users had slightly lower rates than people who had never used it. People who had stopped testosterone had the highest rate, which could mean some people with pain stop taking it. Among 79 people followed as they started testosterone, about one in ten developed new pelvic pain. The study suggests testosterone is not the main cause of long-lasting pelvic pain. But it is mostly a one-time, self-reported survey, so it cannot settle whether testosterone helps or causes pain.

Key findings

• PRIDE अध्ययन के 2,579 ट्रांस पुरुषों और महिला जन्मे नॉन-बाइनरी वयस्कों में से, 457 (18%) को 3 महीने या अधिक चलने वाला पेल्विक दर्द था।
• यह दर्द इरिटेबल बाउल सिंड्रोम (दर्द वालों में 37%), PCOS (20%), फ़ाइब्रॉइड (9%), पिछली गर्भावस्था, योनि प्रसव, और गर्भाशय या अंडाशय निकालने से जुड़ा था।
• लंबे समय तक चलने वाले पेल्विक दर्द वाले लोगों में PTSD (51%), गंभीर अवसाद के लक्षण (42%) और गंभीर चिंता के लक्षण (25%) की बहुत ऊँची दरें थीं।
• पेल्विक दर्द की सूचना वर्तमान टेस्टोस्टेरोन उपयोगकर्ताओं में से 16%, कभी न लेने वालों में 19% और बंद कर चुके लोगों में 23% ने दी; आयु और गर्भाशय निकालने का हिसाब रखने पर, वर्तमान उपयोग लगभग एक-पाँचवें हिस्से कम दर्द से जुड़ा था।
• टेस्टोस्टेरोन शुरू करते समय अनुसरण किए गए 79 लोगों में से, 7 (शुरुआत में दर्द-मुक्त लोगों का लगभग 11%) को 2 साल के भीतर नया लंबे समय का पेल्विक दर्द हुआ।
• टेस्टोस्टेरोन से पहले पेल्विक दर्द वाले 13 लोगों में से, 8 को उस पर पहले साल में भी था।
• लेखक कहते हैं कि यह नहीं मान लेना चाहिए कि पेल्विक दर्द टेस्टोस्टेरोन से होता है, और कि गर्भाशय निकालने से दर्द ठीक होने का कोई दीर्घकालिक साक्ष्य नहीं है।

Abstract

BACKGROUND: There are limited data on pelvic pain among transgender men and gender diverse people, and the impact of testosterone on pelvic pain is poorly understood.

OBJECTIVE: Characterize the prevalence and correlates of chronic pelvic pain (CPP) among transgender men and gender diverse people and examine the association between testosterone use and CPP.

MATERIALS AND METHODS: We used 2020-2022 data from The Population Research in Identity and Disparities for Equality (PRIDE) Study, an online prospective cohort study of sexual and gender minority adults in the United States, to conduct complementary cross-sectional and longitudinal analyses. Our primary outcome was self-reported CPP lasting 3 months or longer measured using the Michigan Body Map.

RESULTS: Among 2579 transgender men and gender diverse people assigned female at birth included in our sample, 457 (18%) reported CPP. CPP correlates included: inflammatory bowel disease, irritable bowel syndrome (IBS), kidney stones, pelvic inflammatory disease, polycystic ovary syndrome (PCOS), uterine fibroids, current hormonal intrauterine device use, prior pregnancy, vaginal delivery, hysterectomy, and oophorectomy. Individuals with CPP reported a high prevalence of IBS (37%), PCOS (20%), uterine fibroids (9%), post-traumatic stress disorder (51%), and severe depression and anxiety symptoms (42% and 25%, respectively). Current testosterone use was associated with a 21% lower prevalence of CPP (adjusted prevalence ratio (aPR) 0.79, 95% confidence interval [CI]: 0.65-0.96). In longitudinal analyses (N = 79), 15 (19%) participants reported any CPP after initiating testosterone: eight (56%) of whom reported CPP prior to testosterone initiation, and seven (47%) who reported new-onset CPP.

DISCUSSION AND CONCLUSIONS: The relationship between CPP and testosterone is complex. Although testosterone use was associated with a lower prevalence of CPP, some transgender and gender diverse individuals experienced new-onset pelvic pain after testosterone initiation. Given the significant impact that CPP can have on mental health and quality of life, future research must examine the role of testosterone in specific underlying etiologies of CPP and identify potential therapies.

Conclusion

The relationship between CPP and testosterone is complex. Although testosterone use was associated with a lower prevalence of CPP, some transgender and gender diverse individuals experienced new-onset pelvic pain after testosterone initiation. Nearly one in five TGD people assigned female at birth experienced CPP. Testosterone may reduce or resolve pelvic pain for some, while for others it may be associated with changes to the urogenital and reproductive environment that cause new-onset pelvic pain. The authors advise that CPP should not be assumed to be caused by testosterone, and that patients seeking hysterectomy for pelvic pain should be counselled about the lack of long-term effectiveness data. Given the significant impact of CPP on mental health and quality of life, future research must examine the role of testosterone in specific underlying causes and identify therapies.