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. 2025 Mar;13(3):600-609.
doi: 10.1111/andr.13703. Epub 2024 Jul 16.

Chronic pelvic pain among transgender men and gender diverse adults assigned female at birth

Diana M Tordoff  1 , Mitchell R Lunn  1   2   3 , Annesa Flentje  1   4   5 , Diana Atashroo  6 , Bertha Chen  6   7 , Zubin Dastur  1 , Micah E Lubensky  1   4 , Matthew Capriotti  1   8 , Juno Obedin-Maliver  1   3   6
Affiliations

Chronic pelvic pain among transgender men and gender diverse adults assigned female at birth

Diana M Tordoff et al. Andrology. 2025 Mar.

Abstract

Background: There are limited data on pelvic pain among transgender men and gender diverse people, and the impact of testosterone on pelvic pain is poorly understood.

Objective: Characterize the prevalence and correlates of chronic pelvic pain (CPP) among transgender men and gender diverse people and examine the association between testosterone use and CPP.

Materials and methods: We used 2020-2022 data from The Population Research in Identity and Disparities for Equality (PRIDE) Study, an online prospective cohort study of sexual and gender minority adults in the United States, to conduct complementary cross-sectional and longitudinal analyses. Our primary outcome was self-reported CPP lasting 3 months or longer measured using the Michigan Body Map.

Results: Among 2579 transgender men and gender diverse people assigned female at birth included in our sample, 457 (18%) reported CPP. CPP correlates included: inflammatory bowel disease, irritable bowel syndrome (IBS), kidney stones, pelvic inflammatory disease, polycystic ovary syndrome (PCOS), uterine fibroids, current hormonal intrauterine device use, prior pregnancy, vaginal delivery, hysterectomy, and oophorectomy. Individuals with CPP reported a high prevalence of IBS (37%), PCOS (20%), uterine fibroids (9%), post-traumatic stress disorder (51%), and severe depression and anxiety symptoms (42% and 25%, respectively). Current testosterone use was associated with a 21% lower prevalence of CPP (adjusted prevalence ratio (aPR) 0.79, 95% confidence interval [CI]: 0.65-0.96). In longitudinal analyses (N = 79), 15 (19%) participants reported any CPP after initiating testosterone: eight (56%) of whom reported CPP prior to testosterone initiation, and seven (47%) who reported new-onset CPP.

Discussion and conclusions: The relationship between CPP and testosterone is complex. Although testosterone use was associated with a lower prevalence of CPP, some transgender and gender diverse individuals experienced new-onset pelvic pain after testosterone initiation. Given the significant impact that CPP can have on mental health and quality of life, future research must examine the role of testosterone in specific underlying etiologies of CPP and identify potential therapies.

Keywords: chronic pelvic pain; gender‐affirming care; testosterone; transgender.

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Conflict of interest statement

Dr. Obedin‐Maliver received consultation fees from Ibis Reproductive Health, Hims Inc., Folx Health Inc., Sage Therapeutics, and Upstream Inc., on topics unrelated to this work. Dr. Lunn received consultation fees from Hims Inc., Folx Health Inc., Otsuka Pharmaceutical Development and Commercialization, Inc., and the American Dental Association on topics unrelated to this work. Dr. Chen consults with Hims Inc. All other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Longitudinal analysis of chronic pelvic pain among transgender men and gender diverse participants before and after testosterone initiation, The Population Research in Identity and Disparities for Equality (PRIDE) Study, 2020–2022.
See this image and copyright information in PMC

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