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Studies have found that the prevalence of PCOS is higher than 50% (varying widely between 14 and 92%) in treatment-naïve transmasculine individuals, i.e., individuals assigned female at birth who identify as men and have not received hormonal treatments.[1],[2],[3]

In this article we explore the specific challenges for transmasculine individuals with PCOS.

Transgender, gender-diverse and non-binary individuals experience significant health disparities in both accessing gender-affirming services and addressing their broader healthcare needs, including: [4],[5],[6],[7],[8],[9]

  • Lack of providers with expertise in transgender medicine due to educational and knowledge gaps or low level of comfort working with gender-diverse patients;

  • Lack of financial resources to pay for care, including inadequate insurance coverage and/or lack of income;

  • Poor prior experience of seeking care due to provider discrimination and/or lack of cultural competence as well as historical focus on helping individuals to conform to binary gender expression;

  • Paucity of research focused on gender-diverse populations, including failure to capture transgender identity within health records;

  • Structural health system barriers, including unreliable records, outdated forms, lack of appropriate facilities and oversimplified rules/alerts based on binary gender paradigm;

  • High prevalence of chronic conditions such as HIV/AIDS, substance use disorders and depression/anxiety disorders as a result of minority stress; and

  • Other socioeconomic barriers, including higher rates of unemployment, higher rates of housing insecurity/homelessness, higher rates of contact with the criminal justice system and lack of family support driven by minority stress.

These barriers may be further exacerbated for transgender youth who often experience systemic barriers to transitioning and are particularly vulnerable to internalizing their negative experiences in seeking care.[10]

For transgender individuals the challenges of managing a complex, chronic condition can be exacerbated:[11],[12]

  • Lack of research on chronic disease within this population beyond HIV/AIDS, in particular with regards to age-related conditions;

  • Increased complexity and burden of disease from physical and mental health co-morbidities;

  • Potential complications from receiving gender affirming surgery and/or gender affirming hormone therapy (GAHT), although the impacts are not well understood and existing literature is highly contradictory.[13]

There are a number of specific features of PCOS which could add potential complexity to diagnosis and treatment in transmasculine individuals:[14]

  • The naming of the condition as polycystic ovarian syndrome, linking the condition to female reproductive organs, despite the core characteristic being androgen excess, is likely exclusionary;

  • The convention of referring to PCOS as a women’s health condition through as cisnormative lens could be exclusionary both to seeking and receiving care;

  • Referring to PCOS as a reproductive health condition (within women’s health), understates the cardiometabolic and other risk factors associated with the condition;

  • Some of the visible symptoms of PCOS, such as hirsutism, may not create the same level of concern for transmasculine individuals and therefore may delay seeking care until other symptoms and/or complications develop;

  • Diagnosis of PCOS, based on androgen levels, would become challenging for those individuals receiving GAHT;

  • Historical treatment of PCOS has focused on masking symptoms such as irregular periods and hirsutism so likely are of even less value to transmasculine individuals; and

  • Some physicians may be reluctant to proceed with GAHT under the misapprehension that testosterone treatment will exacerbate metabolic issues (studies have shown that hormone treatment with testosterone in transgender men does not produce the metabolic disturbances seen in individuals with PCOS or result in ovarian cysts).[15],[16]

Reviewed by Keila Turino Miranda, an expert on PCOS and cardiovascular outcomes in transgender men

Want to learn more about the hormonal disturbances associated with PCOS?  Check out our articles on androgen excess, Anti-Müllerian hormone and Luteinizing hormone.

PCOS and Transmasculine Individuals

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