Assessing the role of ultrasound in uterine bleeding among patients on gender-affirming testosterone: a retrospective cohort study

Our study found no significant differences in pelvic ultrasound findings between transgender and gender-diverse individuals on testosterone with and without uterine bleeding, suggesting that routine ultrasound has limited diagnostic utility in this population. Given the multifactorial nature of bleeding on testosterone, including hormonal and metabolic influences, a trial of medical management may be preferable before imaging in low-risk individuals - particularly given risk that vaginal ultrasounds could exacerbate gender dysphoria.