Endometriosis is Not Only a Cis Woman’s Condition
Cisgender females are persons whose gender identity coincides with the sex that they were assigned at birth. The transmasculine gender spectrum (transmasc) includes transgender men and gender-nonbinary persons whose sex assigned at birth was female.
Within the field of obstetrics and gynecology, much of the research on the transmasculine population has been dedicated to fertility preservation, hysterectomies and the reproductive changes associated with gender-affirming hormone therapy. Up until now, Endometriosis has rarely been mentioned in the transmasculine population.
Menstruation may be a concern of transmasculine persons as it can play a huge role in gender dysphoria. Transmasculine people are often keen to suppress menstruation for this reason.
Lack of Endometriosis Awareness
Endometriosis is a condition where tissue similar to the lining of the womb grows in other areas, usually on organs in the pelvic area but can sometimes even spread as far as the lungs. Symptoms include but are not limited to, pelvic pain, infertility and extremely painful periods. Endometriosis affects not only the uterus and not only women.
There is a lack of info about the condition online as it is. It is also a condition that many people have for years before realizing, thankfully in recent years much-needed awareness has been raised online, especially social media. Many sufferers are left to research their symptoms themselves after being misdiagnosed or not having the term Endometriosis even mentioned to them. I myself was the one who mentioned it to my doctor, after showing various symptoms for over 12 years.
Importance of Early Endometriosis Diagnosis
Endometriosis is notorious for drawn-out diagnosis, due to the difficulty in diagnosing the condition. It is of great importance that those who are planning/going through transition get diagnosed as soon as possible. A delay in diagnosis can affect infertility in terms of impacting the utilization and/or the outcomes of fertility preservation.
The purpose of a recently published study was to investigate how dysmenorrhea (extremely painful periods) is managed in transmasculine adolescents at Boston Children's Hospital. The study also had secondary aims of describing the presentation of endometriosis in transgender men and their treatment outcomes and also analyzing the effects that testosterone initiation had on dysmenorrhea in transmasculine adolescents.
The study entitled ‘Dysmenorrhea and Endometriosis in Transgender Adolescents’, published in the Journal of Paediatric and Adolescent Gynaecology, enrolled 35 transmasculine people who had already received the diagnosis of dysmenorrhea (extremely painful periods). Below is an overview of their findings:
· Only 7 transgender men with dysmenorrhea (20%) were laparoscopically evaluated for endometriosis, and it was confirmed in all 7
· The mean age at diagnosis was 15.7 years
· 3 (42.9%) were diagnosed after social transition, with 1 diagnosed after initiation of testosterone
The study focused on adolescents with dysmenorrhea. The majority of complications with menstrual health begin during adolescence- with endometriosis symptoms often then being reported. However, it is important to note that,
“Endometriosis has been found in cis males (born male), trans males, pre-menarcheal girls and postmenopausal women.”
Testosterone and Endometriosis
Although taking low-dose testosterone usually stops periods, the effects of Endometriosis will remain in the person's body for life.
The use of puberty-blocking or masculinizing hormones may alter the way in which conditions like endometriosis present — hormones such as testosterone inhibit menstruation but may also mask the presence and symptoms of endometriosis in some cases.
This could result in an under-representation of endometriosis in the transmasc population who are taking testosterone.
Danazol as a Possible Treatment
Another important point raised in the study in terms of treatment was the consideration of unorthodox treatments for endo in trans men. In cisgender women the use of Danazol to treat endometriosis is not normally considered in modern times.
Danazol was one of the first treatments developed for endometriosis, but is no longer often used due to its androgenic effects. Women taking Danazol noted unwanted masculinizing side effects like hair growth and deepening of the voice, depending on the dose. The use of Danazol as a preferential medical therapy for endometriosis treatment in trans men is a possibility, but much more research is required.
Cori Smith and His Endometriosis Journey
Endometriosis is a condition that takes a toll on not only your physical health but your mental health too. This is only worsened for those who are not cis women. Cori Smith is a trans man from Rochester, New York, and he is living with Endometriosis.
Cori’s journey with Endo started when he was 13, like with many others — the first indication of Endo was heavy and painful periods. Following diagnostic laparoscopy surgery and ablation at 16 Cori was prescribed birth control pills, IUDs and progesterone. Cori then went on to have a further 4 laparoscopic ablations. Although after beginning his transition, his periods stopped, but the Endo symptoms did not go away, with the return of cramps and spotting after months on testosterone.
“A lot of trans men in general, a lot of them will completely avoid going to the OB-GYN just because it’s a female thing, and it gives them a lot of anxiety and a lot of stress.”
Cori Smith
Cori claimed that his treatment at URMC was transphobic and disrespectful. In November 2017, he filed a civil lawsuit against the hospital.
According to the suit, a doctor performed one oophorectomy each in two separate, back-to-back surgeries during his two-day stay. When he awoke from the first surgery with the remaining grapefruit-sized ovary, he alleges in the lawsuit that he was denied pain medication and was forced to undergo an excruciating transvaginal ultrasound in front of gawking nurses.
He claims the doctor did go back in to perform the second oophorectomy, but that the doctor denied him a hysterectomy — which was scheduled for two weeks later — allegedly telling Cori that he “didn’t feel comfortable aiding in [his] transition.” Cori claims he woke up from the second oophorectomy with a bowel obstruction and an ileus (a painful obstruction in the small intestine).
Cori alleges that his caretakers at URMC discriminated against him because of his he was trans. Cori stated the lawsuit is an intersection of the mistreatment of endometriosis pain and discrimination towards trans people.
“It’s not just a trans issue, it’s how doctors treat people with endometriosis sometimes. They don’t always take the disease seriously. They don’t always give the patient proper credit.”
-Cori Smith
Not Just a Cis Woman’s Issue
Research into Endometriosis needs to be inclusive so that all sufferers regardless of sexuality or gender can receive live-improving treatment.
This was the first study into Endometriosis in the transgender population. Seven transmasculine adolescents with varying gender-affirming treatment histories, had endometriosis that was laparoscopically confirmed.
Three of the patients achieved resolution of endometriosis-associated symptoms with conventional endometriosis therapies, two experienced improvements after beginning testosterone therapy, and two experienced persistent symptoms despite testosterone use and therefore they required continuation of progestin therapies in conjunction.
In addition to this gendered language needs to be removed from all aspects of research and treatment into Endometriosis.
“It is imperative to look beyond gendered health and include all people in endometriosis, many of whom are already struggling to access diagnosis, quality treatment and supportive care in a traditionally female identified space.”
- CenterForEndo.com
Endometriosis is not just a cis woman’s condition.
