Trans men ‘becoming postmenopausal’ in their 20s

Michael Searles,Health Correspondent

26 May 2024 •

The original article is here.

Transgender men are suffering from “postmenopausal” problems like incontinence in their 20s because of taking testosterone, a study has revealed.

Experts analysed 68 transgender men who were taking the cross-sex hormone to change their identity from female to male and found that 95 per cent had developed pelvic floor dysfunction.

The participants, who were as young as 18 and had an average age of 28, had bladder and bowel symptoms that medics would expect to see in a woman after the menopause.

Experts said the impact of the sex-changing drugs on bodily functions are under-researched and under-reported, with people “not being informed of the risks at gender clinics”.

Around 87 per cent of the participants had urinary symptoms such as incontinence, frequent toilet visits and bed-wetting, while 74 per cent had bowel issues including constipation or being unable to hold stools or wind in. Some 53 per cent suffered from sexual dysfunction.

The researchers said the rate of urinary incontinence, where urine unintentionally leaks, was around three times higher in transgender men than women, affecting around one in four compared to eight per cent of the general female population.

Other trans men suffered from frequent urinating including during the night, burning sensations, hesitancy, urgency and difficulty in going, while others had issues defecating.

Almost half had an “orgasm disorder”, while a quarter suffered from pain during sexual intercourse.

Elaine Miller has been working with detransitioners seeking help for pelvic floor issues

Elaine Miller has been working with detransitioners seeking help for pelvic floor issues CREDIT: Chris Watt/Chris Watt

Experts warned that the drugs were putting young people on “exactly the same trajectory” as those going through the menopause. A third of the participants in the study were students.

Elaine Miller, a pelvic health physiotherapist and member of the Chartered Society of Physiotherapy, said: “A lot of women are absolutely fine until the menopause and then they start to get leaky. That appears to be exactly the same trajectory for female people who take cross-sex hormones, but there hasn’t been much in the way of research.”

She said she had worked with around 20 detransitioners who sought help for pelvic floor issues – and many more from around the world had been in touch – but that there was a “stigma” around incontinence and that people were “embarrassed” and minimised the issue.

“Wetting yourself is something that just is not socially acceptable, and it stops people from exercising, it stops them from having intimate relationships, it stops them from travelling, it has work impacts,” she said.

“The impact a bit of leaking has on these young people’s lives is huge. It really needs to be properly discussed within gender clinics because I would expect that almost 100 per cent of female people that take cross-sex hormones will end up with these problems,” she added, noting that the study was “robust” and probably underplayed the issue.

“It’s really sad when we hear people say, ‘nobody ever told me this’, and they should have been informed of the risks in gender clinics.”

The menopause causes a loss of muscle mass and body strength, which affects the pelvic floor and can cause incontinence.

Women who start the menopause early or prematurely, under the age of 45, should be offered Hormone Replacement Therapy (HRT) on the NHS because the oestrogen can help prevent the onset of conditions such as coronary heart disease, osteoporosis and dementia.

Taking testosterone may accelerate the menopausal process because it stops the ovaries from functioning and reduces the amount of oestrogen the body produces.

Testosterone is also known to affect muscle mass and hair loss, and has been linked to blood clots and gallstones, but there has been little research into pelvic floor issues and incontinence.

Ms Miller said the treatment for trans men was “the same as with any other postmenopausal female, which seems kind of ludicrous when you’re talking about people that are in their early 20s”.

“It’s making sure they are not constipated, getting them into a routine where they are not dehydrating themselves because they’re worried about having an accident. A lot of it is about bladder and bowel education about what is normal, and doing pelvic floor exercises, which can make a big difference,” she added.

Kate Barker, chief executive at the LGB Alliance, said the group had “consistently spoken out about the damage done by these experimental surgeries, the overwhelming majority of which are carried out on LGB [lesbian, gay and bisexual] people”.

“Our annual conference has heard testimony from detransitioners who live every day with the consequences of actions they took when they were very young – sometimes in their teens – including permanent sterilisation and loss of sexual function,” she said. “This has finally been officially confirmed by the Cass Review.”

The Cass Review saw the NHS stop prescribing puberty blockers outside of clinical trials and a pause to cross-sex hormones being given to under 18s. It called for more care to be given in the treatment of under 25s and the health service is reviewing adult clinics as a result.

The authors of the study, led by Lyvia Maria Bezerra da Silva at the Federal University of Pernambuco, Brazil, said the findings “showed a high frequency of at least one of the pelvic floor dysfunction symptoms” and that more research into the impact of testosterone was needed because the “long-term effects are still unknown”.

The research was published in the International Urogynecology Journal.

© Telegraph Media Group Limited 2024

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