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Dolore pelvico cronico nel 18% di uomini trans e adulti non binari; per alcuni comparso dopo l'inizio del testosterone

Dolore pelvico cronico tra uomini transgender e adulti di genere diverso assegnati femmine alla nascita

Studi di coorte e registroOrmoni cross-sex
Authors
Diana M. Tordoff, Mitchell R. Lunn, Annesa Flentje, Diana Atashroo, Bertha Chen, Zubin Dastur, Micah E. Lubensky, Matthew Capriotti, Juno Obedin-Maliver
Journal
Andrology
Year
2025
Source
https://doi.org/10.1111/andr.13703

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

  • Su 2.579 uomini trans e adulti non binari nati femmine del PRIDE Study, 457 (18%) avevano dolore pelvico di durata pari o superiore a 3 mesi.
  • Questo dolore era associato a sindrome dell'intestino irritabile (37% di chi aveva dolore), PCOS (20%), fibromi (9%), gravidanze precedenti, parto vaginale e asportazione di utero od ovaie.
  • Le persone con dolore pelvico di lunga durata avevano tassi molto alti di PTSD (51%), sintomi di depressione grave (42%) e sintomi di ansia grave (25%).
  • Il dolore pelvico era riferito dal 16% degli utilizzatori attuali di testosterone, dal 19% di chi non l'aveva mai usato e dal 23% di chi aveva smesso; tenendo conto di età e asportazione dell'utero, l'uso attuale era associato a circa un quinto in meno di dolore.
  • Tra 79 persone seguite mentre iniziavano il testosterone, 7 (circa l'11% di chi non aveva dolore all'inizio) hanno sviluppato un nuovo dolore pelvico di lunga durata entro 2 anni.
  • Di 13 persone che avevano dolore pelvico prima del testosterone, 8 lo avevano ancora nel primo anno di terapia.
  • Gli autori dicono che il dolore pelvico non andrebbe presunto come causato dal testosterone, e che non ci sono prove a lungo termine che l'asportazione dell'utero curi il dolore.

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.