Pelvic pain in transgender individuals on testosterone therapy

Study reveals high prevalence of pelvic pain in transgender individuals on testosterone therapy

Key Points

Highlight:

• Pelvic pain is a common issue in trans individuals undergoing testosterone therapy.
• There is a need for further research and individualized approaches to managing pelvic pain in the trans population receiving testosterone therapy. 

Importance:

• Addressing pelvic pain in trans individuals is crucial for providing effective gender-affirming healthcare.
• Understanding the characteristics and associated factors can guide treatment approaches.

What's done here:

• An exploratory study was conducted using an online survey to investigate pelvic pain in trans individuals on testosterone therapy.
• Data on demographics, testosterone usage, pelvic pain characteristics, and associated factors were collected. 

Key results:

• Out of 486 participants, 72.2% of respondents experienced pelvic pain after starting testosterone therapy.
• The most common types of pain reported were cramping, aching, stabbing, and sharp pain.
• Factors associated with pelvic pain included persistent menstruation, post-traumatic stress disorder diagnosis, and pain with orgasm.
• Analgesic medications (nonsteroidal anti-inflammatory drugs, paracetamol) were commonly used for pain management.
• Hysterectomy showed relief for some participants with pelvic pain. 

Strength and Limitations:

• Being the largest study to date exploring pelvic pain in trans individuals on testosterone therapy and providing valuable insights into the characteristics and associated factors of pelvic pain in this population are the strengths.
• Potential sampling bias, potential responder bias, recall bias due to participants being asked to recall experiences before starting testosterone, self-reported medical conditions without confirmation of diagnoses, and lack of information on specific anatomical variations and sexual activities are the limitations.

Lay Summary

Pelvic pain is a common issue among individuals assigned female at birth who are transgender or gender diverse (referred to as trans individuals) and are undergoing testosterone therapy as part of their gender-affirming hormone treatment. However, this topic remains poorly understood, despite the growing demand for gender-affirming healthcare globally. 

Aiming to shed light on the characteristics of pelvic pain in trans individuals undergoing testosterone therapy and explore potential factors associated with the onset of pelvic pain after starting hormone treatment, the researchers conducted an exploratory study by recruiting participants from a larger Australian trans health study and performed an online survey. They collected data on demographics, testosterone usage, pelvic pain characteristics, and potential associated factors. The study was published in the April 2023 issue of the journal LGBT Health. 

A total of 486 trans people participated in the study. Of the respondents, 72.2% experienced pelvic pain after starting testosterone therapy, with 90% reporting pain "sometimes" and 10% reporting pain "always or almost always." The most common type of pain reported was cramping, followed by aching, stabbing, and sharp pain. The pain was predominantly located in the hypogastric region. Participants reported similar levels of pain severity after starting testosterone therapy compared to before treatment. Factors associated with pelvic pain after starting testosterone therapy included persistent menstruation, a current or previous diagnosis of post-traumatic stress disorder, and pain with orgasm. The most commonly used treatments for pelvic pain were analgesic medications, particularly nonsteroidal anti-inflammatory drugs, and paracetamol. Hysterectomy was indicated for some participants with pelvic pain, with the majority reporting a reduction in pain following the surgery.

It is discussed that treating pelvic pain in this population is challenging and requires a multidisciplinary approach. The self-management strategies such as over-the-counter pain relievers and heat therapy are commonly used in the general population, however, these may be less effective in transgender individuals due to irregular bleeding. The authors add that hysterectomy and/or oophorectomy have provided relief for some individuals, but further research is needed. In addition, pelvic floor physical therapy may be a low-risk treatment option. They conclude by saying that there is a potential connection between testosterone therapy and pelvic floor muscle dysfunction and highlighting the importance of a multidisciplinary approach in managing pelvic pain, including addressing pain management, sexual function, persistent menstruation, and mental health.

Research Source: https://pubmed.ncbi.nlm.nih.gov/36603056/