A systematic review and meta-analysis in the October 2026 issue of eClinicalMedicine (vol. 100), publicised on October 5, 2026, estimates that about 39% of transmasculine people taking gender-affirming testosterone have pelvic pain (95% CI 23–55%). The authors say it is the first study to pool the prevalence and clinical course of pelvic pain in this group, and it challenges a common belief among clinicians and patients that moving from an oestrogen-dominant to an androgen-dominant hormonal profile protects against pelvic pain. The team was led by Susanna Weidlinger, with co-authors including Niggli, van Trotsenburg and Feil. It searched four databases for studies from 2013 to June 2026 and included 11 studies from five countries (six from the US), covering 4,176 transmasculine individuals, 2,891 of them on testosterone.

Why It Matters

This is a sexual-health and product-design gap the industry has mostly ignored. Testosterone-related vaginal atrophy and dyspareunia are, mechanically, the same problem that menopause brands are building a whole category around: moisturisers, lubricants, dilators, pelvic-floor therapy and vaginal oestrogen. Yet almost none of that marketing, product testing or clinical evidence includes transmasculine bodies. A 39% pooled prevalence, with high persistence, means a large and under-served user base for gender-inclusive pelvic-health products, pain-aware toy design (smaller insertables, external-first stimulation, gentle vibration profiles) and inclusive pelvic-floor physiotherapy. It also complicates the "T fixes it" assumption in some gender-affirming care pathways. Clinics and telehealth services that start testosterone now have a pooled evidence base telling them to screen for pelvic pain at baseline and keep following up. The weak primary data are a research opportunity for any femtech or sexual-wellness company willing to fund a properly instrumented prospective cohort, since there isn't one yet.

The course of existing pain matters most clinically. Among people who had pelvic pain before starting testosterone, it persisted in a pooled 72% of cases and improved or resolved in only 26%. One study reported worsening in 24% of participants. About 31% of people without prior symptoms reported new-onset pain after starting T, but that estimate rests on three very different studies with a 5–65% confidence interval. Prevalence was 28% in non-surgical cohorts and 50% in surgical cohorts, where pain was often recorded as an indication for hysterectomy. Among people not on testosterone it was 41%, statistically indistinguishable from users. That gives no evidence that T either protects against or causes pelvic pain.

The data are messy, and the authors say so. Heterogeneity (I²) exceeded 99% for most estimates, no included study used a validated pain-assessment tool, and confounding was rarely addressed. The authors also flag a possible incentive to record pelvic pain in surgical cohorts, because US insurers often require a documented medical indication for gender-affirming hysterectomy. They describe a multifactorial picture. Testosterone causes vaginal epithelial atrophy similar to genitourinary syndrome of menopause, which can raise the risk of dyspareunia. One large study cited found nearly two-thirds of transmasculine people experienced vulvovaginal pain during sex. Ovaries are not reliably suppressed, with signs of recent ovulation found in roughly 30–40% of people at oophorectomy. Pelvic-floor dysfunction was reported in 94% of T users in one study. Minority stress and barriers to care also appear to amplify pain.

The clinical recommendations are concrete. Clinicians should tell patients before treatment that pelvic pain is common and that T does not reliably resolve it, evaluate gynaecological conditions before starting T, continue gynaecological follow-up even after periods stop, and use inclusive, trauma-informed care, including self-collected specimens. For research, the authors point to the newly validated Transmasculine and Gender Diverse Pelvic Symptom Index as the first gender-affirming instrument built for this population.

Sources

Update — 2026-10-06

Initial entry — story first created.