Endometriosis in Transgender Men: A Call for Inclusive Healthcare

June 24, 2024

By Genester Wilson-King, MD FACOG

Healthcare providers must embrace inclusivity and acknowledge the diverse backgrounds, genetics, ethnicities, genders, and sexual preferences of their patients. As a board-certified OB/Gyn with a specialization in cannabis use in women’s health, I have researched the application of cannabis for managing conditions such as endometriosis for years. A concerning issue has surfaced regarding the prevalence of endometriosis among transgender men, which demands proper attention and immediate action.1

Context

The term “transgender” refers to individuals whose gender identity is different from the gender assigned to them at birth. “Trans” is a common, shortened term. A trans man refers to someone whose gender expression is that of a man but was assigned female at birth. Cisgender refers to people who identify as the gender they were assigned at birth.2 Some trans men menstruate and can experience both physical and psychological pain during this time. Trans men face discrimination and stigma when seeking menstrual and reproductive health care, which can lead to negative experiences ranging from verbal harassment to outright denial of care.3 These challenges can be compounded when it comes to navigating endometriosis.

Endometriosis is a chronic, multi-system disease that impacts roughly one in every seven to ten individuals assigned female at birth. It is traditionally associated with women but it significantly affects transgender men as well. It can cause debilitating symptoms such as heavy menstrual bleeding, painful periods, gastrointestinal issues, and discomfort during intercourse and urination. This combination of factors can impair the psychological, social, and economic well-being of those affected. These impacts are even more pronounced in transgender and gender-diverse individuals, who often face barriers to accessing basic healthcare. They are also more likely to encounter mental health issues and discrimination based on social, housing, and employment environments.4

Disproportionate Impact on Trans Men

Recent studies noted that transgender and gender-diverse individuals experience a higher incidence of chronic pelvic pain compared to cisgender people. A new investigation found that chronic pelvic pain impacts 51% to 72% of the transgender male population compared to 26.6% of cisgender females. This can have a disproportionate impact on trans men dealing with endometriosis since pelvic pain is a common symptom.1,4

Cisgender women with endometriosis frequently experience delays in diagnosis since the condition is commonly misdiagnosed. There are also limited treatment options for endometriosis in general. The challenges for transgender men are exacerbated by several factors. Diagnostic delays for trans men are further compounded due to physician bias and a general lack of education regarding their medical care. A lack of awareness among healthcare providers can lead to a misdiagnosis or a dismissal of symptoms. Sometimes pain associated with endometriosis is attributed to a patient’s hormonal therapies or previous surgeries. The lack of preparedness among healthcare providers can hinder the effective treatment of endometriosis in trans men, which contributes to unfavorable health outcomes​.1

Continuing Education

To address healthcare disparities, it is crucial to reform medical education for people of all genders dealing with endometriosis. Education in medical schools and continuing education (CME) programs need to make sure more healthcare providers are well-informed and equipped to handle the specific needs of all people, including transgender individuals. The current curriculum should evolve to include comprehensive care principles for cisgender women and gender-diverse individuals. This approach should be compassionate and avoid pathologizing or stigmatizing patients. All individuals must receive timely and appropriate care for their unique situation.1,4

Final Note

The call for an inclusive approach in healthcare is not just about improving individual health outcomes, but should also support a system that respects and validates the identity and experiences of all patients, particularly those from marginalized communities. Healthcare providers can take significant steps toward more equitable healthcare for everyone, including transgender men with endometriosis. This comes by integrating comprehensive education and advocating for informed, unbiased care practices. A transformational future is on the horizon. May it shed light on new ways of approaching optimal health for all beings.

References

  1. Vallée, A., Feki, A., & Ayoubi, J. M. (2023). Endometriosis in transgender men: recognizing the missing pieces. Frontiers in Medicine, 10.
  2. National Center for Transgender Equality. (n.d.). Understanding transgender people: The basics. Accessed on June 17, 2024.
  3. Fitzsimons, T. (2020, January 20). For transgender men, pain of menstruation is more than just physical. NBC News. Accessed on June 17, 2024.
  4. Jeffrey, S., Ashton, L., Ferfolja, T., & Armour, M. (2024). Transgender and gender diverse people with endometriosis: A perspective on affirming gynaecological care. Women’s Health, 20(1), 17455057241251974.