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18%的跨性別男性和非二元成年人報告有慢性骨盆疼痛；一些人在開始使用睪固酮後出現新的疼痛

出生時被指定為女性的跨性別男性和性別多元成年人的慢性骨盆疼痛

世代與登記研究跨性激素治療
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

  • 在 PRIDE 研究 2,579 名出生時為女性的跨性別男性與非二元性別成人中，457 人（18%）有持續 3 個月或更久的骨盆疼痛。
  • 這種疼痛與腸躁症（有疼痛者的 37%）、PCOS（20%）、肌瘤（9%）、過去懷孕、陰道生產，以及子宮或卵巢切除有關。
  • 有長期骨盆疼痛的人，PTSD（51%）、嚴重憂鬱症狀（42%）和嚴重焦慮症狀（25%）的比率非常高。
  • 目前使用睪固酮者有 16% 回報骨盆疼痛，從未使用者 19%，已停用者 23%；考慮年齡和子宮切除後，目前使用與約五分之一較少的疼痛有關。
  • 在開始使用睪固酮時被追蹤的 79 人中，7 人（一開始沒有疼痛者的約 11%）在 2 年內出現新的長期骨盆疼痛。
  • 在使用睪固酮之前就有骨盆疼痛的 13 人中，8 人在使用的第一年仍有疼痛。
  • 作者表示，不應假設骨盆疼痛是由睪固酮造成的，而且沒有長期證據顯示切除子宮能治癒疼痛。

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.