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).