Lower Urinary Tract Symptom Scores Among Patients Presenting for Gender Affirming Orchiectomy: An Exploratory Analysis

Current literature on baseline voiding function in gender-diverse patients assigned male at birth (AMAB) is limited. We conducted a retrospective analysis of patients presenting for gender-affirming orchiectomy consultation between 2021 and 2024 who completed the American Urological Association symptom score (AUA-SS) questionnaire to characterize baseline urinary symptoms and identify factors associated with symptom-related bother. Demographics, hormone therapy characteristics, and comorbidities were collected. Bother score was analyzed as both an ordinal variable (score 0 = "delighted" to 6 = "terrible") and dichotomized (no bother = "delighted" or "pleased" and some bother = "mostly satisfied" to "terrible"). Twenty-six patients met the inclusion criteria, with a median age of 28 years. Overall symptom burden was low (median AUA-SS 4, IQR 2-7.3), with frequency and nocturia reported most commonly. Despite mild symptoms, most patients did not select the lowest possible bother score ("delighted"). Total AUA-SS and bother were not significantly associated with hormone therapy type or duration. In contrast, those with a documented history of anxiety, depression, or bipolar disorder had significantly higher bother score compared to those without (mean rank 15.3 vs. 9.6, <i>p</i> = 0.04). In this single-center cohort, urinary symptoms were generally mild among AMAB patients seeking gender-affirming orchiectomy. Psychiatric history was associated with a higher bother score, though this relationship was no longer significant when bother was dichotomized. These findings suggest behavioral factors may influence how urinary symptoms are experienced and reported in this population. These findings are exploratory and warrant validation in larger cohorts.