A new study has found that young women who are put on testosterone for gender transition are developing “postmenopausal” problems like incontinence in their 20s because of the cross-sex hormone.
In a study of 68 biological females who identify as transgender men, 95 per cent of participants who were put on testosterone developed pelvic floor dysfunction, sparking fears from researchers that the impact of the drugs on body function is under-researched and under-reported.
The authors of the cross-sectional study, which was led by Lyvia Maria Bezerra de Silva from the Federal University of Pernambuco, Brazil, found that participants – the youngest of whom was aged 18, with an average age of 28 – reported bladder and bowel symptoms that most medics would not anticipate to see in a woman until after the menopause. A third of the participants in the research were students.
Experts said that their objective of the research was to explore the effects of hormone therapy using testosterone on pelvic floor dysfunction (PFD) in transgender men.
“We hypothesise that PFD might be prevalent among transgender men undergoing hormone therapy. Therefore, this study was aimed at verifying the frequency of these dysfunctions,” they noted.
The recently published study was conducted between September 2022 and March 2023, using an online questionnaire which included women over 18 who had undergone “gender-affirming hormone therapy.”
“Volunteers with neurological disease, previous urogynecology surgery, active urinary tract infection, and individuals without access to the internet were excluded,” they said.
The questionnaire employed validated tools to assess urinary symptoms, including urinary incontinence (UI), as well as sexual dysfunction, anorectal symptoms, and constipation.
Researchers said that the study’s findings “showed a high frequency of at least one of the pelvic floor dysfunction symptoms” and that more research into the impact of testosterone was needed because the “long-term effects are still unknown.”
Academics analysed 68 women who identified as transgender men, who had taken the cross-sex hormone to alter their identity from female to male, discovering 95 per cent had developed pelvic floor dysfunction. This led the experts to warn that people are “not being informed of the risks of gender clinics.”
The research, published in the International Urogynecology Journal, found that “most participants had storage symptoms (69.1%), sexual dysfunction (52.9%), anorectal symptoms (45.6%), and flatal incontinence (39.7%). Participants with UI symptoms reported moderate severity of the condition.”
Transgender men on hormone therapy have a high incidence of PFD (94.1%) and experience a greater occurrence of urinary symptoms (86.7%), they said in conclusion.
Researchers said that the rate of urinary incontinence – where urine unintentionally leaks – was around three times higher in trans-identified men than women, affecting around one in four compared to eight per cent of the general female population.
Females at birth who had taken testosterone also suffered from frequent urinating including during the night, burning sensations, hesitancy, urgency and difficulty in going, while others had issues defecating.
Almost half had an “orgasm disorder”, while a quarter suffered from pain during sexual intercourse, researchers noted.
Elaine Miller, a pelvic health physiotherapist and member of the Chartered Society of Physiotherapy, told The Telegraph newspaper in reaction to the study: “The impact a bit of leaking has on these young people’s lives is huge.
“It really needs to be properly discussed within gender clinics because I would expect that almost 100 per cent of female people that take cross-sex hormones will end up with these problems.”
Ms Miller described the study as “robust,” adding: “It’s really sad when we hear people say, ‘nobody ever told me this’, and they should have been informed of the risks in gender clinics.”
“It’s making sure they are not constipated, getting them into a routine where they are not dehydrating themselves because they’re worried about having an accident. A lot of it is about bladder and bowel education about what is normal, and doing pelvic floor exercises, which can make a big difference,” she added.