Is there an association between pelvic pain and gender-affirming testosterone therapy in trans masculine adolescents? An exploratory cross-sectional study.

Background: High rates of pelvic pain have been reported in trans individuals on testosterone, but the pathophysiology of pain and the potential role of testosterone are unclear. Aims: The aim of this exploratory study was to determine whether the proportion of pelvic pain in trans adolescents is different among those on testosterone therapy compared to those who are not. Secondary objectives were to determine the characteristics, potential contributing factors, impact, and treatment of pelvic pain in trans adolescents. Methods: An online cross-sectional study about pelvic pain was conducted among trans individuals assigned female at birth, aged 12 and over, and who had sought care at our institution since 2017. Results: Among 102 participants, 79 (77.5%) reported having experienced pelvic pain over the last 6 months. The proportion of individuals who reported pelvic pain was lower in individuals on testosterone (n = 43/62, 69.4%) compared to those not on testosterone (n = 36/40, 90%), with a difference in proportion of -20.6% (95% CI -35.4 to -5.9%, p = 0.006). Half of participants reported school or work absenteeism and two thirds missed extracurricular activities because of pelvic pain. A wide range of treatment options were used, with variable rates of reported effectiveness. Conclusion: Pelvic pain is frequently reported by trans adolescents. This exploratory study found a lower proportion of pelvic pain in trans adolescents using testosterone therapy compared to those who were not. Nevertheless, this study was limited by a small number of participants, its cross-sectional nature, and the risk of recruitment bias, thus limiting its generalizability. Longitudinal studies are required to better understand the development and evolution of pelvic pain in trans adolescents.