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.