Dysmenorrhea and Endometriosis in Transgender Adolescents

J Pediatr Adolesc Gynecol. 2020 Jun 11;S1083-3188(20)30237-0. doi: 10.1016/j.jpag.2020.06.001. Online ahead of print.


Study objective: To study the presentation of dysmenorrhea and endometriosis in transmasculine adolescents and review their treatment outcomes.

Design: A retrospective review SETTING: Boston Children's Hospital PARTICIPANTS: Transmasculine persons less than 26 years old who were diagnosed with dysmenorrhea and treated between January 1, 2000 and March 1, 2020 INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE(S): An electronic medical record review of the clinical characteristics, transition-related care, and treatment outcomes.

Results: 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.

Keywords: Adolescent; Endometriosis; Testosterone; Transgender.