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테스토스테론 사용자의 72%가 골반 통증을 보고, 그러나 거의 모두 시작 전에도 골반 통증이 있었음

테스토스테론 요법을 쓰는 트랜스젠더 사람들의 골반 통증

설문 조사교차성호르몬
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

  • 설문에 응한 테스토스테론 사용자 486명(전형적인 나이 27세, 테스토스테론 사용 약 2.5년) 중 351명(72%)이 테스토스테론을 시작한 후 골반 통증이 있었다고 했습니다.
  • 통증이 있는 사람 중 90%는 ‘가끔’, 10%는 ‘항상 또는 거의 항상’ 있었고, 전형적인 강도는 10점 만점에 약 6점이었으며 가장 흔한 것은 아랫배의 경련성 통증이었습니다.
  • 테스토스테론 중 통증이 있는 사람의 98%는 시작 전에도 어느 정도 골반 통증이 있었고, 테스토스테론 중의 통증을 이전과 거의 같다고 평가했습니다.
  • 골반 통증은 아직 월경이 있는 사람에서 약 4배, PTSD가 있는 사람에서 2.5배, 오르가슴 중 통증이 있는 사람에서 약 30배 더 가능성이 높았습니다.
  • 통증이 있는 사람의 절반은 그것이 적어도 가끔 성관계를 중단하거나 방식을 바꾸게 했다고 말했습니다.
  • 자궁을 제거한 25명 또는 26명 중 대부분은 이후 통증이 줄었다고 보고했지만, 결론을 내리기에는 수가 너무 적었습니다.
  • 저자들은 골반저 근육의 문제가 역할을 할 수 있다고 시사하며 원인과 치료에 대한 연구를 요구합니다.

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.