背景:已经报道了服用睾酮的跨男性个体的盆腔疼痛。需要进一步调查以增加对这种疼痛的患病率和危险因素的了解。
目的:我们试图确定子宫和卵巢均有服用睾酮的跨男性个体所报告的盆腔疼痛患病率。
方法:我们进行了一项机构审查委员会批准的回顾性研究,研究对象是所有服用睾酮至少1年并在睾酮开始时具有子宫和卵巢的跨男性个体。对参与患者的图表进行了审查,以确定患者特征,睾丸激素的使用,睾丸激素开始之前和之后的盆腔疼痛症状。
结果:患者报告了使用睾酮时盆腔疼痛的经历。
结果:280名服用睾酮至少1年的人中,100(36%)在使用睾丸激素时出现盆腔疼痛。这些病人中,71%(n=71)在开始睾丸激素之前没有经历过盆腔疼痛。有42名患者(15%)在开始睾丸激素之前有盆腔疼痛,13人(31%)一旦开始使用睾丸激素,就不再经历疼痛。睾酮开始时的中位年龄(IQR)为22(19-41)岁,睾酮治疗持续时间为48(27-251)个月。那些在使用睾丸激素时经历盆腔疼痛的患者在开始使用睾丸激素之前也更有可能报告盆腔疼痛(29%vs7%,P<.001)。这些患者也更有可能预先诊断为痛经(27%vs7%,P<.001),子宫内膜异位症(6%vs2%,P=.049),或卵巢囊肿和/或肿块(12%vs2%P<.001)。盆腔疼痛患者也更有可能在睾丸激素开始之前和重叠使用月经抑制剂(22%vs12%,P=.03)并且使用月经抑制持续时间更长(中位数[IQR]18[6-44]vs8[4-15]个月,P=.04)。
结论:盆腔疼痛在开始睾酮治疗的跨男性个体中很常见,虽然睾酮对不同个体的盆腔疼痛有积极和消极的影响。
■这项研究的主要优势包括大量患者,在睾酮之前评估盆腔疼痛的能力,以及确定盆腔疼痛实际患病率的能力。主要局限性包括该研究是在单个三级护理中心进行的回顾性分析,临床文件的局限性,缺乏标准的盆腔疼痛评估过程。
结论:超过三分之一的子宫和卵巢的患者在服用睾酮时出现盆腔疼痛,大多数报告在开始睾酮后出现疼痛。
Pelvic pain has been reported in transmasculine individuals taking testosterone. There is a need for further investigation to increase understanding of the prevalence and risk factors of this pain.
We sought to determine the prevalence of pelvic pain reported by transmasculine individuals who had both a uterus and ovaries and were taking testosterone.
We conducted an institutional review board-approved retrospective study of all transmasculine individuals who had been taking testosterone for at least 1 year and had a uterus and ovaries at the time of testosterone initiation. Charts of participating patients were reviewed to determine patient characteristics, testosterone use, and pelvic pain symptoms both before and after initiation of testosterone.
Patients reported experiences of pelvic pain while on testosterone.
Of 280 individuals who had been on testosterone for at least 1 year, 100 (36%) experienced pelvic pain while on testosterone. Of those patients, 71% (n = 71) had not experienced pelvic pain prior to starting testosterone. There were 42 patients (15%) who had pelvic pain prior to starting testosterone, 13 (31%) of whom no longer experienced pain once starting testosterone. The median (IQR) age at initiation of testosterone was 22 (19-41) years and duration of testosterone treatment was 48 (27-251) months.Those patients who experienced pelvic pain while on testosterone were significantly more likely to have also reported pelvic pain prior to starting testosterone (29% vs 7%, P < .001). These patients were also more likely to have a pre-existing diagnosis of dysmenorrhea (27% vs 7%, P < .001), endometriosis (6% vs 2%, P = .049), or ovarian cysts and/or masses (12% vs 2% P < .001). Patients with pelvic pain were also more likely to have been on a menstrual suppression agent prior to and overlapping testosterone initiation (22% vs 12%, P = .03) and to have used menstrual suppression for longer durations (median [IQR] 18 [6-44] vs 8 [4-15] months, P = .04).
Pelvic pain is common in transmasculine individuals who are initiating testosterone treatment, although testosterone has both positive and negative effects on pelvic pain in different individuals.
The major strengths of this study included large numbers of patients, ability to assess for documentation of pelvic pain prior to testosterone, and ability to determine an actual prevalence of pelvic pain. Major limitations included the study being a retrospective analysis in a single tertiary care center, the limitations of clinical documentation, and the lack of a standard pelvic pain evaluation process.
More than one-third of transmasculine patients with a uterus and ovaries had pelvic pain while on testosterone, with the majority reporting onset of pain after initiating testosterone.