Young women in their 20s who identify as men and are prescribed testosterone as part of “gender-affirming” treatment appear to have a high incidence of both pelvic floor dysfunction (PFD) (94.1%) and urinary problems such as incontinence (86.7%) – symptoms more typically experienced by older women after menopause.
Researchers reported that conclusion in a study published last month in the International Urogynecology Journal.
Da Silva et al at the Federal University of Pernambuco in Brazil examined 68 young women at least 18 years of age but with an average age of 28 who identified as men and underwent so-called “gender-affirming” treatment in order to appear more masculine. All were taking testosterone.
The researchers hypothesized that PFD might be pervasive in women undergoing masculinizing cross-sex hormone treatment. Excluded from the study were volunteers who suffered from neurological disorders, prior urinary/gynecological surgery, and active urinary tract infections.
A questionnaire delivered to participants via the internet “employed validated tools to assess urinary symptoms, such as urinary incontinence (UI), as well as sexual dysfunction, anorectal symptoms, and constipation,” the researchers noted.
Among young women taking testosterone, the results showed a high incidence of PFD (94.1%) and a greater experience of urinary symptoms (86.7%) – including UI, frequent bathroom visits during the night, and bed-wetting.
Additionally, most participants experienced storage problems (69.1%), sexual dysfunction (52.9%), anorectal symptoms (45.6%), and bowel incontinence and flatulence (39.7%). Those women with UI symptoms experienced them as being of moderate severity.
Elaine Miller, a pelvic health physiotherapist and member of the Chartered Society of Physiotherapy in the UK, explained the significance of the study in comments to the Telegraph, noting the prevalence of the problem of incontinence for young women undergoing cross-sex hormone treatment.
Most women, Miller said, “are absolutely fine until the menopause and then they start to get leaky.”
“That appears to be exactly the same trajectory for female people who take cross-sex hormones, but there hasn’t been much in the way of research,” she observed.
Miller said she has cared for about 20 detransitioners who were experiencing pelvic floor concerns – as well as others from around the world who contacted her but perceived a “stigma” around issues of incontinence and felt “embarrassed,” leading them to dismiss the problem:
Wetting yourself is something that just is not socially acceptable, and it stops people from exercising, it stops them from having intimate relationships, it stops them from travelling, it has work impacts. 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.
“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,” Miller added.
The study was published within a couple of weeks of the release of the final report led by British pediatrician Dr. Hilary Cass, whose team concluded the “gender-affirming” medically invasive treatment model is founded on “remarkably weak” evidence.
Cass’ report noted that “multiple studies” were found to show puberty blockers compromise bone density and fertility and can lead to other harmful effects. Additionally, most children and adolescents who are prescribed puberty blockers end up moving on to cross-sex hormones, such as testosterone, which was the focus of the current study.
Cass and her team stressed that while there is little sound clinical evidence for medically invasive treatment for children and adolescents with gender issues, still “the current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty.”
The final report calls for a “holistic assessment” of children and teens referred for gender services, including “screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment.”
In the wake of the Cass report, England’s National Health Service (NHS) ended the prescription to minors of both puberty blockers – outside of clinical research trials – and cross-sex hormones. Additionally, the health service called for greater care to be provided to young adults and for a review of gender treatment clinics treating this age group as well.
NHS also announced proposed changes to its constitution, including defining “sex” as “biological sex” and ending the use of terms that reflect gender ideology.
