Original Research| Volume 33, ISSUE 5, P524-528, October 2020

Dysmenorrhea and Endometriosis in Transgender Adolescents

  • Jessica Y. Shim
    Address correspondence to: Jessica Y. Shim, MD, Division of Gynecology, Department of Surgery, Boston Children's Hospital, 333 Longwood Ave, LO-545, Boston, MA 02115; Phone: (617) 355-5785
    Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts

    Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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  • Marc R. Laufer
    Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts

    Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts

    Center for Infertility and Reproductive Surgery, Brigham & Women's Hospital, Boston, Massachusetts

    Boston Center for Endometriosis, Boston, Massachusetts
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  • Frances W. Grimstad
    Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts

    Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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      Study Objective

      To study the presentation of dysmenorrhea and endometriosis in transmasculine adolescents and review their treatment outcomes.


      A retrospective review.


      Boston Children's Hospital.


      Transmasculine persons younger than 26 years old who were diagnosed with dysmenorrhea and treated between January 1, 2000 and March 1, 2020.


      Not applicable.

      Main Outcome Measures

      An electronic medical record review of the clinical characteristics, transition-related care, and treatment outcomes.


      Dysmenorrhea was diagnosed in 35 transmasculine persons. Mean age was 14.9 years ± 1.9 years. Twenty-nine (82.9%) were diagnosed after social transition. Twenty-three of 35 (65.7%) were first treated with combined oral contraceptives, but 14/23 (61%) discontinued or transitioned to alternative therapy. Twelve patients with dysmenorrhea alone initiated testosterone treatment, and 4/12 (33.3%) experienced persistent symptoms. Seven of 35 patients with dysmenorrhea (20.0%) were laparoscopically evaluated for endometriosis, and it was confirmed in all seven. Six had stage I disease, and one had stage II. Three of the 7 (42.9%) were diagnosed after social transition, with one diagnosed 20 months after initiating testosterone treatment. Their endometriosis was treated with combined oral contraceptives, danazol, or progestins; four experienced suboptimal response during treatment with these therapies alone. Two of those with suboptimal response subsequently resolved their dysmenorrhea when using testosterone. Five patients with endometriosis initiated testosterone treatment, and of the 5 (40%) experienced persistent symptomatology with combined testosterone and progestin therapies.


      To our knowledge, this is the first study to characterize endometriosis in transmasculine persons. Evaluation for endometriosis was underutilized in transmasculine persons with dysmenorrhea, despite those who underwent laparoscopic evaluation and had disease confirmation. Although testosterone treatment can resolve symptoms in some, others might require additional suppression. Endometriosis should be considered in transmasculine persons with symptoms even when they are using testosterone.

      Key Words

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