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.