Management of Abnormal Uterine Bleeding in Transmasculine Individuals

Transmasculine individuals, those who identify as men, transgender men, and non-binary individuals who are sex assigned female at birth, may present to gynecologic care for the management of abnormal uterine bleeding (AUB). The purpose of this review is to better understand the epidemiology, etiology, evaluation of, and management of AUB in transmasculine patients.

There have been a series of single institution studies on AUB in transmasculine patients done in recent years. However, to our knowledge, no reviews have been conducted on this topic.

Causes of AUB can include the same age related causes that may occur in cisgender individuals who are not on testosterone, as well as breakthrough bleeding (BTB) in individuals on testosterone. Options for management of testosterone-related to BTB include adjustments to testosterone dosing and preparation, initiation or discontinuation of a secondary menstrual suppression agent, or surgical approaches. Observation is also an option. Decisions around approach should be patient-centered, and both evaluation and management should proceed with a trauma-informed and gender-affirming lens. Using existing data regarding AUB in transmasculine individuals and best practice guidelines for the provision of gynecologic care of the transgender community, gynecologists can offer a holistic and welcoming approach to caring for patients who present with these concerns.