Transgender and Endometriosis Studies

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“Dysmenorrhea was diagnosed in 35 transmasculine persons. Mean age was 14.9 years ± 1.9 years. Twenty-nine (82.9%) were diagnosed after social transition. Twenty-three (65.7%) were first treated with combined oral contraceptives, but 61% (14/23) discontinued or transitioned to alternative therapy. Twelve patients with dysmenorrhea alone initiated testosterone, and 33.3% (4/12) experienced persistent symptoms. Only seven with dysmenorrhea (20.0%) were laparoscopically evaluated for endometriosis, and it was confirmed in all seven. Six had stage I disease, and one had stage II. Three were diagnosed after social transition (42.9%), with one diagnosed 20 months after initiating testosterone. Their endometriosis was treated with combined oral contraceptives, danazol or progestins; four experienced suboptimal response while on these therapies alone. Two of those with suboptimal response subsequently resolved their dysmenorrhea when utilizing testosterone. Two out of five patients with endometriosis initiated testosterone and experienced persistent symptomatology with combined testosterone and progestin therapies.

Conclusion: This is the first study characterizing endometriosis in transmasculine persons. Evaluation for endometriosis was underutilized in transmasculine persons with dysmenorrhea, despite those who underwent laparoscopic evaluation having disease confirmation. While testosterone can resolve symptoms in some, others may require additional suppression. Endometriosis should be considered in transmasculine persons with symptoms even when utilizing testosterone.”

“This video highlights the importance of evaluating postmenopausal chronic pelvic pain patients for endometriosis by presenting an unusual case of peritoneal endometriosis in a transgender male patient. A 25-year-old nulligravida transgender male presents with a long history of debilitating chronic pelvic pain, despite previous hysterectomy, bilateral salpingo-oophorectomy, and long-term testosterone therapy. Peritoneal endometriosis is visualized laparoscopically involving the posterior cul-de-sac and rectal serosa, and is excised. The histopathology confirms the presence of peritoneal endometriosis in the aforementioned areas. The patient’s recovery is uneventful. At 4 week and 9 month follow-up, the patient reports resolution of his pelvic pain and an improved quality of life.”