Gender-Affirming Testosterone Treatment and Lower Urinary Tract Symptoms

In the United States alone, 1.6 million people identify as transgender and gender diverse. Although transgender individuals commonly report lower urinary tract symptoms (LUTS), the factors underlying these symptoms are poorly understood.

Our primary aim was to compare the severity and effect of LUTS in transgender men/transmasculine individuals taking testosterone therapy with those not taking testosterone. We hypothesize that patients who are using gender-affirming testosterone have less severe LUTS compared with those who are not receiving such treatment.

We conducted a cross-sectional study of transgender individuals assigned female at birth aged 18 years and older receiving care with Obstetrics and Gynecology and Family Medicine within a single tertiary care hospital system. Our primary outcome was LUTS as measured by the Patient Perception of Bladder Condition, a validated single-item questionnaire that queries if participants have bladder symptoms that cause problems.

One hundred thirty-one respondents were included in the analysis: 106 currently taking testosterone and 25 not taking testosterone. Mean age (±SD) for all participants was 30.4 ± 7.2 years. Overall, 108 (82.4%) of participants identified as White and 12 (9.2%) identified as Black. Sixty-nine participants (52.7%) identified as men, and 56 (42.8%) identified as nonbinary. Individuals taking testosterone were 5 times less likely to report moderate-to-severe bladder problems compared with those not taking testosterone: (6.6% [7/106] vs 36% [9/25], P <0.001).

Genderaffirming testosterone therapy was associated with less bothersome LUTS in our population of transgender men/transmasculine individuals. Further research will be necessary to elucidate the nature of and underlying reason for this relationship.