Endometriosis Among Transgender and Gender Diverse Patients Imaging Study (ETRIS).

OBJECTIVE

To assess the prevalence of surgically confirmed endometriosis among assigned-female-at-birth (AFAB) transgender and gender diverse (TGD) individuals undergoing laparoscopic pelvic surgery.

DESIGN

Retrospective multicenter cohort study from 2021 to 2024.

SETTING

Three academic medical centers in the Netherlands and the United Kingdom.

PARTICIPANTS

Eligible participants were AFAB TGD individuals aged ≥18 years who underwent pelvic laparoscopic surgery for any indication, including gender incongruence/dysphoria.

INTERVENTIONS: Data on demographics, medical history, and diagnostic imaging were analyzed using descriptive statistics. Surgical confirmation of endometriosis was the primary outcome.

RESULTS

Among 325 participants, endometriosis prevalence was 3.1% (n = 10). The mean age of participants was 27.2 years and the mean body mass index (BMI) 24.9. Testosterone was predominantly used before surgery (95.4%), and among these users, 38.5% had been on testosterone for 5 or more years at the time of surgery. Overall, 6% of the sample reported dysmenorrhea, and among those with endometriosis, 30% experienced dysmenorrhea.

CONCLUSION

Endometriosis was present in 3.1% of the sample. This finding differs from previous literature as it reports a lower prevalence compared to cisgender women and to other studies on TGD people. This is potentially due to prolonged use of testosterone and early initiation of gender-affirming care (GAC).