METHODS
We conducted an online cross-sectional survey of trans individuals using
testosterone GAHT utilising a non-probability snowball sampling
approach. The survey was open between 28th August 2020
to 31st December 2020 to Australian residents over the
age of 16 years who identified as part of the trans community and were
using testosterone for gender affirmation. The survey was designed
collaboratively by our core team of researchers (SZ, AWFQ, TC, KE) who
are members of the Australian trans community, and clinicians
specialised in trans healthcare.
Survey data were collected and managed using REDCap electronic data
capture tools hosted at The University of Melbourne. The study received
ethical and governance approval by the Austin Health Human Research
Ethics Committee (Reference Number HREC/57155/Austin-2019), ACON
Research Ethics Review Committee (Reference Number 2020/03) and the
Thorne Harbour Health Community Research Endorsement Panel (Reference
Number THH/CREP 20-006).
Written informed consent was not obtained, however the survey preamble
outlined that completing the survey implied consent. Inclusion criteria
were assessed via three screening questions: a) currently living in
Australia; b) identification as trans (“is your gender different to
what was presumed for you at birth?”); and c) aged 16 years or older.
Participants in this study were recruited from a larger longitudinal
Australian trans health study known as TRANSform . Participants inTRANSform were recruited using a non-probability snowball
sampling approach with recruitment calls posted on social
media (Facebook and Instagram) and via over 100 trans and gender diverse
community support groups and organisations in Australia.
A total of 670 participants who indicated that they were using
testosterone therapy for gender affirmation were emailed an
individualised link to a survey titled “Pain experiences in trans men
and trans masculine people using testosterone survey”. A small
participation incentive (AUD$5 gift card) was provided for completion.
Survey questions are outlined in detail in the Appendix. In brief,
demographic data and testosterone formulation, dosage and duration of
use were obtained. Participants were asked to provide self-reported
testosterone concentrations. Participants were asked to describe
characteristics and location of pelvic pain and rate severity as well as
compare the presence of pelvic pain prior to and after commencing
testosterone therapy for gender affirmation.
Potential associated factors were explored including persistent
menstruation; presence of genital dryness; history of hysterectomy or
oophorectomy; presence of pain with sexual activities; use of
intrauterine device; known diagnoses of depression, anxiety, PTSD,
endometriosis, vulvodynia (pain in the area around the vulva, not
necessarily with touch), or vaginismus (involuntary tightening of the
muscles around the vagina, not necessarily with penetration). The number
of pregnancies (including miscarriages and terminations) and number of
live births was also determined.
Participant characteristics are reported as frequency (percentage) for
categorical variables, and median (standard deviation), or median
(interquartile range) as appropriate for not normally distributed data,
are included. Logistic regression was used to estimate the effects of
the possible factors contributing to pain on the odds of experiencing
pain after starting testosterone. The factors considered in the
regression were selected prior to performing the analysis based on
potential risk factors for pelvic pain from expert opinion (given the
lack of published research in this field). Results are reported as odds
ratios with corresponding 95% confidence intervals (CI). This is a
complete case analysis with an alpha level of 5% (P<0.05)
considered statistically significant. Statistical
analyses were performed using R version 4.0.2 (R Foundation for
Statistical Computing, Vienna, Austria).