A recent qualitative study with transgender and gender diverse participants yielded some insights regarding genitourinary health issues.
“Many transgender and nonbinary people are on gender-affirming hormone therapy, yet we don’t have a really clear picture of how gender-affirming hormone therapy affects the genitourinary system. So our goal is to understand people’s lived experiences on gender-affirming hormone therapy as it relates to their urinary and sexual health,” said first author Paige De Rosa, MD, urology resident at the University of Iowa. , Iowa City.The study was presented at the North Central Section of the American Urological Association Annual Meeting in Chicago, Illinois.
De Rosa and medical anthropologist Ana-Monica Racila, PhD, conducted semi-structured virtual interviews with 23 participants; questions included demographics, sexual health, bathing habits, urinary health, and reproductive health. The age of the participants ranged from 18 to 61 years. “Participants identified their gender using terms including nonbinary, male, transgender woman, transfemme, and transgender male. [Seven] participants were assigned male at birth and 16 were assigned female at birth,” the authors wrote.
De Rosa said one of the key findings from the interviews was the change in interviewees’ bathroom habits, “particularly holding urine until a single stall or gender-neutral stall is made available.”
“Many transfeminine people describe sitting down to urinate. Some people found this to be a gender-affirming practice, and some people felt compelled to do so by social pressures, to conform to gender norms, both for safety and simply to blend in. And then, specifically, some transfeminine people reported a sensation of incomplete bladder emptying when they sat down to urinate,” De Rosa added.
De Rosa said many transfeminine participants reported increased urinary frequency when taking spironolactone. In addition, transmasculine interviewees reported pungent urine, increased sweat production, and increased perineal hair growth after starting testosterone treatment.
Participants also discussed changes in their libido and experience of orgasm, with some transfeminine interviewees reporting “a general increase in their sensitivity to non-genital touch, as well as slower building orgasms,” De Rosa said. In addition, transmale participants who started testosterone noticed an erotic sensation that was more localized to the genitals and an increase in their libido.
“What was really interesting to hear wasn’t just the physical changes people were going through on gender-confirming hormones, but [also] how did this affect those who had experienced dealing with pyelonephritis, nephrolithiasis, [urinary tract infections] […] it leads to consequences for your health… We know that people hold urine, but not so much about the prevalence of urinary tract infections and young people who develop pyelonephritis from holding urine all day at school, and what it feels like for them, De Rosa said.
At the conclusion of their abstract, the investigators wrote about the goal of improving patient-provider communication.
“What we hope is that our work will help the practicing urologist become familiar with some of the common GU concerns of transgender and gender-fluid people. We want urologists to recognize the need to lower barriers to accessing gender-affirming health care. I think urologists are willing to do that,” De Rosa said Urology Times®.
Specific steps urologists can take in their practice, De Rosa said, include gender-neutral bathrooms in the office, using gender-neutral patient forms, displaying lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA). , and training all office staff on LGBTQIA-inclusive health care practices.
1. De Rosa P, Racila AM, Pearlman A. A qualitative study exploring the perspectives of transgender and gender diverse participants on gender-affirming hormone therapy and the genitourinary system. Presented at: North Central Section of the AUA Annual Meeting, August 28-31, 2022, Chicago, Illinois. Abstract 14