Pelvic Pain in Transgender People Using Testosterone Therapy

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.

Pain mechanisms in the transgender individual: a review

“…When androgens do reduce pain, the reduction coincides with its attenuating effects on inflammation ( 151 ). However, it has been shown that pelvic pain in transgender men often occurs after initiation of testosterone therapy ( 152 ). Given the known androgen sensitivity of the pelvic floor musculature ( 153 ), further research into pelvic floor muscle dysfunction is warranted.…”

Endometriosis in transgender men: recognizing the missing pieces

“…Testosterone therapy, which is commonly used during gender transition, can influence the symptoms and presentation of endometriosis in transgender men ( 12 ). The hormonal changes brought about by testosterone can mask or alter typical symptoms, such as changes in menstrual patterns or pelvic pain ( 13 ). Healthcare providers must be knowledgeable about these potential variations to ensure accurate diagnosis.…”

“…A significant number of transgender individuals seek hysterectomy and/or oophorectomy as part of their gender affirmation process or due to persistent pelvic pain or abnormal bleeding. Among those who underwent hysterectomy, 72% reported experiencing relief from pelvic pain symptoms following the procedure ( 13 ). This surgery effectively stops ongoing menstruation, which is particularly prevalent in those experiencing pain after beginning testosterone therapy.…”

Growing Past Women's Health

“…10 I was surprised to learn that testosterone use itself can lead to pelvic pain through pelvic floor dysfunction due to the anabolic effect of the hormone. 11 Before an aside from my preceptor in clinic that day, no one had ever mentioned testosterone as a potential etiology of pelvic pain. As a result, this was not something originally on my differential when I saw that first patient.…”

“…10 I was surprised to learn that testosterone use itself can lead to pelvic pain through pelvic floor dysfunction due to the anabolic effect of the hormone. 11…”