Chronic Sex

The following is a press release from The PRIDE Study, the first longitudinal study of LGBTQIA+ individuals. It came out October 1, 2024:

Publication Title

Contraceptive use among transgender men and gender diverse individuals in the United States: reasons for use, non-use, and methods used for pregnancy prevention.

Community Title

Understanding if and why transgender men and gender diverse people assigned female or intersex at birth use contraception (“birth control”)

What Did We Do?

We focused the study on understanding transgender and gender-diverse (TGD) people’s history of using contraception (commonly called “birth control”) specifically for the goal of not getting pregnant, and how use of birth control is different (or not) among TGD people who also use testosterone. We asked TGD people who were assigned female or intersex at birth in The PRIDE study to take a survey with questions on their own birth control use, their reasons for birth control use, and about their testosterone use.

What Was New, Innovative, or Notable?

This is one of the first studies to look at birth control use to avoid pregnancy among TGD people who were assigned female or intersex at birth.

TGD people who were assigned female or intersex at birth may want or need to use birth control. However, much research on contraception has left out or overlooked the needs and experiences of TGD people. As a result, some people, including doctors, have incorrect information about contraception methods and considerations for TGD people. For instance, among people who use testosterone to affirm their gender, it is common to hear the belief that testosterone prevents pregnancy; but this is not fully true and standard forms of birth control are still recommended if pregnancy is not desired and people engage in penis-in-vagina sex. Similarly, it is common to hear TGD people say that their doctor did not know how to counsel them on birth control options.

What Did We Learn?

Among the 1,694 TGD individuals assigned female or intersex at birth who completed the survey, most (71%) had used at least one type of birth control in their lifetime. Out of this group, about half (49%) had used birth control because they wanted to avoid getting pregnant. Other common reasons for birth control use included a desire to avoid period symptoms, stop menstrual bleeding, and avoid getting a sexually transmitted infection.

Participants reported the use of a wide range of birth control methods.

The types of birth control that were most commonly used AT SOME POINT in participants’ lives were:

• Condoms (92%)
• Hormonal birth control pills (63%)
• Withdrawal (“Pulling out”)( 46%)

The types of birth control that participants were most commonly CURRENTLY using included:

• External condoms (35%)
• Hormonal IUD (small t-shaped device inserted into the uterus that contains hormones) (25%)
• Not having sex where sperm is released in/near a vagina (19%)

Some people said that they had previously (7%) or were currently (4%) relying on testosterone hormones to avoid getting pregnant. Participants who had ever used testosterone were less likely to be currently using birth control with hormones in it (birth control pills/birth control patch/birth control ring) to avoid pregnancy compared to participants who had never used testosterone. The most common reason for never using birth control was if the participant did not engage in penis-in-vagina sex. The most common non-pregnancy-related reason for not using birth control was a desire to avoid estrogen or feminizing hormones out of a worry that it might impact their gender affirmation process.

What Does This Mean for Our Communities?

Each TGD person has different needs when it comes to their desire to get pregnant or not and their reasons to use birth control – which can include gender affirmation and avoiding period symptoms. Our study shows that providers should not make assumptions about interest in the use and type of birth control for TGD people. Instead, doctors and advocates can ask and counsel TGD patients on all available birth control methods, centering the needs and goals of the individual. We need to consider an individual’s potential fears, including that birth control could interfere with their hormone treatment and whether or not their body reflects the way they feel about their gender.

What’s Next?

We will work to share these findings with as many relevant groups as we can – transgender men and gender diverse people, healthcare providers, policymakers, advocates, and more – so that we all have the data we need to plan for and prevent pregnancies. Additionally, our team is hard at work preparing a 5-year update of this study to measure birth control needs and experiences among an expanded sample of transgender men, transgender women, and gender diverse participants in The PRIDE Study today. We’re looking forward to seeing if and how birth control experiences and preferences have changed since 2019, and how we can ensure that TGD people receive the highest quality care and support the ability to make their own informed decisions in their reproductive lives.

Action Steps

See http://pridestudy.org/study for more information and to share this study with your friends and family.

Citation

Obedin-Maliver J, Snow A, Ragosta S, Fix L, Hastings J, Lubensky ME, Capriotti MR, Dastur Z, Flentje A, Lunn MR, Moseson H. Contraceptive use among transgender men and gender diverse individuals in the United States: reasons for use, non-use, and methods used for pregnancy prevention. Contraception. 2024 Sep 26: 110719. Epub ahead of print. doi: https://doi.org/10.1016/j.contraception.2024.110719.

The following is a press release from The Pride Study, dated July 16, 2024:

What Did We Do?

Chronic pelvic pain describes pain in the lower abdomen, pelvis, or genitals that lasts 3 months or more. In our study, we looked at how common chronic pelvic pain was among transgender men and gender diverse people assigned female at birth (AFAB). We also wanted to understand how testosterone use may or may not impact chronic pelvic pain. To do this, we used 3 years of data from The PRIDE Study participants (Annual Questionnaires from 2020, 2021, and 2022). We looked at patterns of chronic pelvic pain overall. We also looked at how starting testosterone therapy impacted chronic pelvic pain over time.

What Was New, Innovative, or Notable?

This is the largest published study conducted on chronic pelvic pain among transgender and gender diverse people, a topic on which little is known.

What Did We Learn?

• Chronic pelvic pain was common. About 1 in 5 (or 18%) of transgender men and gender diverse people AFAB experienced chronic pelvic pain lasting 3 months or more.
• Participants with the following health conditions were more likely to experience chronic pelvic pain: inflammatory bowel disease (like Crohn’s disease and ulcerative colitis), irritable bowel syndrome (IBS), kidney stones, pelvic inflammatory disease (PID), polycystic ovary syndrome (PCOS), and uterine fibroids. People who currently had an implanted device to prevent pregnancy or who had ever been pregnant were also more likely to experience chronic pelvic pain.
• Individuals with chronic pelvic pain reported worse mental health. 51% had a post-traumatic stress disorder (PTSD) diagnosis, 42% reported severe depression symptoms, and 25% reported severe anxiety symptoms.
• We saw that people who currently used testosterone were 21% less likely to experience chronic pelvic pain.
• We saw that some people (about 1 in 10) experienced pelvic pain for the first time after starting testosterone. In contrast, about half of people who reported chronic pelvic pain before testosterone use no longer reported experiencing chronic pelvic pain after starting testosterone.

What Does This Mean for Our Communities?

Chronic pelvic pain is common among transgender men and gender diverse people AFAB. It can have a large impact on mental health and overall well-being. This research suggests that testosterone may reduce pelvic pain for some individuals; while for others, testosterone may be associated with changes that cause new pelvic pain.

It is important that clinical providers do not assume that all cases of chronic pelvic pain among transgender people are caused by testosterone use. Instead, they should take comprehensive health histories and assess symptoms prior to testosterone use. In fact, for some people, testosterone may reduce pelvic pain. We think that testosterone may reduce pelvic pain that is caused by menstruation and endometriosis, a condition in which cells similar to the lining of the uterus grow outside the uterus. For individuals who experience new pelvic pain after starting testosterone, there are known ways in which testosterone would cause changes to the uterus or ovaries that may cause this. In these cases, there may be effective and low-risk therapies available (for example: pelvic floor physical therapy) to improve symptoms. Notably, pelvic pain is the most common reason transgender people report for seeking uterus removal (other than for gender affirmation), but there have been no long-term studies determining if this is an effective treatment for pelvic pain.

What’s Next?

Chronic pelvic pain has many different and sometimes overlapping causes. Treatment approaches for chronic pelvic pain should be customized based on the underlying causes. There is a need to further study the underlying causes of chronic pelvic pain and how testosterone impacts them to develop better treatments for transgender communities.

Action Steps

See http://pridestudy.org/study for more information and to share this study with your friends and family.

If you are interested in conducting research related to LGBTQIA+ health, please learn more about collaborating with The PRIDE Study at http://pridestudy.org/collaborate.

Citation

Tordoff DM, Lunn MR, Flentje A, Atashroo D, Chen B, Dastur Z, Lubensky ME, Capriotti M, Obedin-Maliver J. Chronic Pelvic Pain among Transgender Men and Gender Diverse Adults Assigned Female at Birth. Andrology. 2024; 1-10. doi: https://doi.org/10.1111/andr.13703.