Background & Aims

Gender minority (GM) patients are an understudied population despite the fact that GM patients account for roughly 1.4 million adults in the United States. Existing data show higher rates of chronic pain syndromes in sexual minority (SM) persons and GM persons compared to heterosexual and cisgender populations. Chronic pain is a common, complex, and challenging condition and it has been shown that patients of female sex assigned at birth experience a higher incidence of most chronic pain syndromes compared to patients assigned male sex at birth (without taking gender into account). Gender-affirming hormone therapy (GHT) is a treatment that aims to induce physical changes in patients that align with their gender identity. The effect of GHT on chronic pain in GM patients has yet to be studied. The goal of this study is to understand the prevalence, characteristics, and types of chronic pain and chronic overlapping pain conditions (COPCs) in GM persons taking GHT.

Methods

Inclusion criteria included adults ages 18 and older who identify as a gender minority and are English speaking. Exclusion criteria included non-English speaking persons and those who declined participation. After screening, informed consent, and enrollment into the study, participants completed numerous questionnaires including demographics, type and duration of GHT (if taking), presence of clinical pain, the Brief Pain Inventory, the COPC Screener, the 2016 Revised American College of Rheumatology Fibromyalgia Diagnostic Criteria Survey, the Childhood Traumatic Events Scale, PainDETECT, PROMIS-29v2.0, the Perceived Stress Scale (PSS), Coping Strategies Questionnaire-Catastrophizing, the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults, the UCLA Loneliness Scale, and the Medical Mistrust Index. Descriptive statistics were used to characterize the cross-sectional cohort and inferential statistics were performed to evaluate our hypotheses.

Results

A total of 103 participants were recruited. This cohort ranged in age from 18-67 years old, and was comprised of 29 transgender men (TGM), 50 transgender women (TGW), and 24 Other Gender persons ((OG) – all assigned female at birth persons). 93% of the cohort reported currently taking GHT. A total of 49% of the enrolled participants reported the presence of chronic pain. The mean number of COPCs present was 1.6 for the total cohort and 2.2, 1, and 2.1 for TGM, TGW, and Other Gender participants respectively. The percentage of the total cohort with 1 COPC was 26% (n=27) and with 2-8 COPC’s was 34% (n=35). (n=27) and with 2-8 COPC’s was 34% (n=35). Stratified by gender identity, 13.6% of TGM, 10.7% of TGW, and 9.7% of Other Gender persons had 2-8 COPCs. The PSS score was found to be associated with the presence of chronic pain, with an odds ratio of 1.1 (95% CI: 1.04, 1.18, p=0.0012). COPCs were noted to be significantly increased in TGM and OG persons compared to TGF (p=0.0102).

Conclusions

These data highlight the significant presence of chronic pain and COPCs in cohorts of gender minority persons. TGM and OG persons were noted to have significantly increased numbers of COPCs compared to TGW. Persons taking masculinizing therapy were also noted to have increased prevalence of 2-8 COPCs compared to those taking feminizing therapy of whom a majority had 0-1 COPCs. The severity of nociplastic pain (also known as fibromyalgianess) was found to be statistically significantly increased in TGM and OG persons and those taking masculinizing therapy compared to TGF and those taking feminizing therapy. Limitations of the present research include the cross-sectional nature of the study design. A large knowledge gap exists regarding the temporal impact of GHT on subjective and objective measures of pain, and thus presents a unique opportunity to study how GHT may influence the presence and severity of pain in gender minority persons using a rigorous longitudinal design.

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Presenting Author

Andrea Chadwick

Poster Authors

Andrea Chadwick

MD

University of Kansas School of Medicine

Lead Author

Grace Merchant

Lead Author

Courtney Marsh

MD

Lead Author

Taylor Cusick

Lead Author

Quinn Jackson

MD

Lead Author

Sharon Fitzgerald

Lead Author

Miranda McMillan

MS

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Nociplastic and chronic widespread pain