A Systematic Review of the Prevalence of Endometriosis in Trans Men.

OBJECTIVE

This systematic review aims to synthesize available evidence on the prevalence of endometriosis in the trans male population.

DATA SOURCES: A systematic review search was conducted using five databases: MEDLINE (OVID), EMBASE, Cochrane Library, Web of Science (via Clarivate), and CINAHL Complete (EBSCO), which were searched between January 2000 and February 2024.

METHODS OF STUDY SELECTION: Studies were eligible for inclusion if they: (1) included transgender, transsexual, or trans male individuals as the study population; (2) included participants reporting one or more of the following conditions: endometriosis, pelvic pain, or dysmenorrhoea; (3) were published in a peer-reviewed journal in English between 1 January 2000 and 1 February 2024. Abstracts were screened and reviewed for relevance. Reviewers independently assessed the full-text articles. Data was extracted from the full-text articles using the data extraction tool, Covidence systematic review software 2024. The risk of bias was evaluated using the Risk Of Bias In Non-randomized Studies of Interventions tool.

TABULATION, INTEGRATION, AND

RESULTS

Of 90 articles screened, 13 were included comprising 1,597 trans men, with a mean age of 26.7 years (SD: 8.1 years). The pooled prevalence of endometriosis was 8.9% (126/1423, 95%CI: 7.4-10.5%). Seven of the studies reported specifically on surgical diagnosis of endometriosis, with a similar prevalence noted in this subset of participants of 9.2%; (50/543; 95% CI: 7.1-11.9%). Those diagnosed with endometriosis were found to have stage 1 disease in 40% of cases (10/25). Non-menstrual pelvic pain was reported by 580 of 1076 participants (53.9%; 95%CI: 50.9-56.9%), dyspareunia by 221 of 566 (39.0%; 95%CI: 35.0-43.2%), dysmenorrhea by 106 of 383 (27.7%; 95%CI: 23.0-32.0%), and abnormal uterine bleeding by 181 of 818 (22.1%; 95%CI: 19.0-25.0%). Testosterone use was reported in 926 of 1,413 participants (65.5%; 95%CI: 63.0-68.0%), with a mean treatment duration of 2.4 years (SD: 1.1 years).

CONCLUSION

This systematic review determined a prevalence of endometriosis of 8.9% in the trans male population. Notably, both the low volume of data and potential for bias in studies based on surgical presentation are limitations. There is a high rate of pelvic pain reported among trans male participants, with 53.9% reporting non-menstrual pelvic pain.