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Introduction: Gender dysphoria is associated with increased rates of anxiety, depression, and suicidal ideation in adolescents. There is anecdotal evidence that menstruation increases the occurrence of gender dysphoria in adolescent transgender males. We hypothesize that menses are distressing to transgender males and this population would benefit from menstrual management.

Methods: We conducted a retrospective chart review of all transgender male patients seen in the Nemours Gender Wellness Program (GWP) and limited our population to those who have reached menarche. Data was extracted from the encounters at the GWP clinic and recorded in REDCap. We compared self-reported symptoms of gender dysphoria at 3 months, 6 months, and one year following an individual’s baseline visit to the GWP. The incidence of gender dysphoria at subsequent visits will highlight the efficacy of treatment.

Results: Preliminary results show that a majority of our population reported significant gender dysphoria related to menses. Of patients reporting gender dysphoria at the initial visit, 84% chose to use menstrual suppression. Patients who chose an IUD at the initial visit had a higher incidence of breakthrough bleeding and gender dysphoria at the first follow up visit compared to patients who chose other menstrual suppression methods.

Conclusion: Menstruation is associated with increased gender dysphoria in transgender male adolescents. Menstrual suppression has the potential to be a transformative treatment for this population. Further research is necessary to determine whether the potential harm that could result from prolonging the distress associated with menses justifies the benefits of using an IUD.



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