Strengths and Limitations
This study has multiple limitations. As this was an online survey
recruited through non-probability snowball sampling, this may have
encouraged a greater proportion of responders who were younger
individuals and may not be representative of the broader trans
community. Of the 670 people participating in the largerTRANSform study who indicated they were using testosterone
therapy and were invited to participate in this testosterone and pain
study, 486 responded, corresponding to a response rate of 72.5%. There
may well have been responder bias, with individuals experiencing pain
syndromes more likely to respond and overrepresenting the proportion of
individuals on testosterone experiencing pelvic pain. Further, as
participants were asked to recall experiences from prior to commencing
testosterone, there is the possibility of recall bias. Medical
conditions and testosterone levels were self-reported, and we were
unable to confirm diagnoses or blood test results. We also acknowledge
that questions regarding penetrative sexual activities did not specify
vaginal or anal penetration. Standardised questionnaires for sexual
dysfunction were not included, and these are not validated for trans and
gender diverse populations. The impact of testosterone therapy on sexual
function warrants further investigation.
Despite the limitations, this survey is the largest study to date
exploring pelvic pain in trans people using testosterone therapy and is
hypothesis generating for future studies examining the pathophysiology
of, or the effectiveness of interventions on pelvic pain.