Phenotypic characteristics of chronic pain and pain-related factors in gender minority persons: a cross-sectional study

Gender minority (GM) persons have been reported to experience chronic pain at higher rates than the general population, yet comprehensive pain phenotyping in this group remains underexplored. The goal of this cross-sectional study was to characterize chronic pain and pain-related factors in GM persons and examine associations of these characteristics with gender identity and gender-affirming hormone therapy (GHT). One hundred three GM adults completed validated questionnaires assessing pain characteristics and severity, sleep, fatigue, stress, trauma, and the chronic overlapping pain condition (COPC) screener. Participants included those who identify as transgender men (TGM), transgender women (TGW), and gender-expansive persons (all assigned female sex at birth). Overall, 50.5% of the entire cohort reported the presence of chronic pain. Transgender men and gender-expansive persons reported greater pain severity, pain interference, fibromyalgianess, stress, and sleep disturbances compared with TGW. Widespread pain was common (36%-45.8% across groups), and 15.5% of the entire cohort met criteria for fibromyalgia. Transgender men and gender-expansive individuals also had increased numbers of COPCs than TGW. Stress, but not GHT type or gender identity, was significantly associated with chronic pain in multivariable models. Chronic pain and nociplastic symptoms are highly prevalent among GM persons, particularly among TGM and gender-expansive persons, and stress appears to be a key contributor to the pain phenotype. These findings underscore the need for longitudinal research into the biopsychosocial drivers of chronic pain in the GM population and the effects of GHT on pain in GM persons.