Tabernacki Tomasz, Gilbert David, Rhodes Stephen, Scarberry Kyle, Pope Rachel, McNamara Megan, Gupta Shubham, Banik Swagata, Mishra Kirtishri
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
University Hospitals Urology Institute, Cleveland, Ohio, USA.
Eur J Pain. 2025 Feb;29(2):e4725. doi: 10.1002/ejp.4725. Epub 2024 Sep 20.
Chronic pain, affecting approximately 20% of the global population, is the leading cause of disability worldwide. Transgender individuals are disproportionately exposed to chronic pain risk factors compared with the cisgender population. This study compares the incidence of chronic pain between transgender and cisgender individuals and examines the impact of gender affirming hormone therapy, anxiety, and depression on chronic pain.
The study analysed medical records data of 56,470 transgender men and 41,882 transgender women in the TrinetX database. Six cohorts were created: transgender women either receiving oestrogen or no intervention, transgender men receiving testosterone or no intervention and cohorts of cisgender males and females. Unmatched age-adjusted incidence rates were calculated. Then cohorts were matched on 22 chronic pain-associated covariates and the rate of new chronic pain diagnoses was compared between those receiving hormone therapy and those without.
We observed significantly higher rates of chronic pain among transgender individuals compared with cisgender counterparts. Transgender men on testosterone therapy and transgender women on oestrogen therapy exhibited an increased likelihood of chronic pain diagnoses compared with those not receiving hormone therapy. Individuals with anxiety and depression were more likely to be diagnosed with chronic pain.
This study demonstrates a significant burden of chronic pain in transgender individuals, with an increased risk among those receiving hormone therapy. Our study, the first to assess chronic pain in a large cohort of transgender patients, provides support for a potential association between hormone therapy and risk of chronic pain diagnosis. Further research is required to understand causal mechanisms and to develop improved screening and management of chronic pain in transgender populations.
Our study, featuring the largest cohort of Transgender and Gender Diverse (TGD) individuals assembled to date, reveals critical disparities in chronic pain among TGD populations, notably those on hormone therapy, compared with the cisgender population. It highlights the urgent need for specialized screening and treatment for this vulnerable population, and research into hormone therapy's impact on pain. These insights aim to foster more effective, personalized healthcare, enhancing the well-being and quality of life for the TGD community.
慢性疼痛影响着全球约20%的人口，是全球残疾的主要原因。与顺性别者相比，跨性别者面临慢性疼痛风险因素的比例更高。本研究比较了跨性别者和顺性别者之间慢性疼痛的发生率，并探讨了性别确认激素治疗、焦虑和抑郁对慢性疼痛的影响。
该研究分析了TrinetX数据库中56470名跨性别男性和41882名跨性别女性的医疗记录数据。创建了六个队列：接受雌激素治疗或未接受干预的跨性别女性、接受睾酮治疗或未接受干预的跨性别男性以及顺性别男性和女性队列。计算未匹配的年龄调整发病率。然后根据22个与慢性疼痛相关的协变量对队列进行匹配，并比较接受激素治疗者和未接受激素治疗者之间新的慢性疼痛诊断率。
我们观察到，与顺性别者相比，跨性别者的慢性疼痛发生率显著更高。接受睾酮治疗的跨性别男性和接受雌激素治疗的跨性别女性与未接受激素治疗者相比，慢性疼痛诊断的可能性增加。患有焦虑和抑郁的个体更有可能被诊断为慢性疼痛。
本研究表明跨性别者中慢性疼痛负担较重，接受激素治疗者的风险增加。我们的研究首次评估了一大群跨性别患者的慢性疼痛，为激素治疗与慢性疼痛诊断风险之间的潜在关联提供了支持。需要进一步研究以了解因果机制，并改善跨性别群体中慢性疼痛的筛查和管理。
我们的研究汇集了迄今为止最大规模的跨性别和性别多样化（TGD）个体队列，揭示了TGD人群与顺性别人群相比在慢性疼痛方面的关键差异，特别是那些接受激素治疗的人群。它强调了对这一弱势群体进行专门筛查和治疗以及研究激素治疗对疼痛影响的迫切需求。这些见解旨在促进更有效、个性化的医疗保健，提高TGD群体的幸福感和生活质量。
