Impact of Gender Dysphoria on Lower Urinary Tract Symptoms and Overactive Bladder

INTRODUCTION: Gender dysphoria can be manifested in many physical, sexual, and behavioral symptoms. To date, most population data regarding prevalence of lower urinary tract symptoms (LUTS) is within the context of cisgender women, and data concerning TGD (transgender and gender diverse) individuals primarily focuses on LUTS after genital gender-affirming surgery (GAS). It remains unknown, irrespective of surgery, how gender dysphoria and severity thereof may relate to the potentiation of LUTS and overactive bladder (OAB) compared to cisgender individuals. OBJECTIVE: The objectives of the study were to compare the prevalence of LUTS and OAB between TGD assigned female at birth (AFAB) individuals and cisgender females, and to identify if gender minorities demonstrate increased LUTS as they experience increased gender dysphoria. METHODS: We conducted an IRB-approved cross-sectional web-based survey study using Research Match. Participants were excluded from the survey if assigned male at birth, intersex, or had history of genital GAS. Baseline demographics and possible contributing variables were also collected, including PROMIS evaluations of anxiety, depression, instrumental support, and a Social Determinants Of Health (SDOH) questionnaire. In the TGD AFAB group, quantification of gender dysphoria was determined through the UGDS-GS (Utrecht Gender Dysphoria Scale–Gender Spectrum). These scales were selected for their gender-neutral language and validation in both male and female populations. RESULTS: A total of 300 AFAB persons agreed to be contacted to access the survey; 250 surveys were completed, and 30 excluded. The final cohort of n=220 was distributed as follows: 34.1% nonbinary, 25% cisgender, 20.9% transgender male, 9.1% transmasculine, 8.6% genderqueer, and 2.3% not otherwise specified AFAB persons. Approximately 45.5% of cisgender female and 36.4% of TGD AFAB survey respondents were identified with OAB. Unadjusted analysis did not demonstrate significant association of one’s gender group with LURNSI10 score (p=0.843) or presence of OAB (p=0.232). Irrespective of gender group, there was a direct correlation noted between LURNSI score and PROMIS evaluations of Anxiety, Depression, and SDOH stressors (p<0.001 for all), which is consistent with prior reports regarding biopsychosocial impact on LUTS. Multivariate regression analysis controlling for psychosocial factors revealed again that one’s gender group (cisgender female or TGD AFAB) was not significantly associated with LURNSI10 score (p=0.112, 95% CI=[ −2.651, 0.28]). However, those in the TGD AFAB group were found to have lower odds of OAB compared to the cisgender group (OR 0.86, p=0.048, 95% CI=[0.735, 0.998]). Among the TGD AFAB group, there was not a relationship demonstrated between LURNSI10 score and degree of gender dysphoria measured by UGDS-GS (rho=−0.026, p=0.74). CONCLUSIONS: This study confirms that several factors are contributory to the outcomes of LUTS and OAB. Those experiencing gender dysphoria may exhibit LUTS at similar rates to the cisgender female population, with both populations demonstrating the significant impact of biopsychosocial factors on LUTS (Figure 1).