Photo Credit: Pranithan Chorruangsak

Factors affecting the link between pain and gender identity include chest binding and the need to modify one’s gender to avoid being misgendered, among others.

In a study examining the experiences of transgender and gender-diverse youth (TGD) living with chronic and recurrent pain, researchers found that they have diverse experiences, perspectives, and healthcare needs. The results published in Pediatrics underscore the need for more intersectional and affirming pain research and integration of outcomes into clinical practice.

For the study, Katelynn Boerner, PhD, and colleagues conducted semi-structured interviews with youth via Zoom. Patients were recruited from a Canadian tertiary care pediatric hospital, community-based clinics, and the general population. Inclusion criteria included patients aged 13-17 years who identified as gender diverse and lived with chronic or recurrent pain.

The 19 youth (mean age, 15.79) involved in the study represented a variety of gender identities and pain conditions and reported accessing a range of types and levels of care. The most reported gender identities included nonbinary (n=7; 37%) and transgender man/male/masculine (n=7; 37%). Most youth (74%) reported experiencing musculoskeletal pain, followed by headache/migraine (37%). Co-occurring psychiatric conditions among patients were anxiety (63%) and depression (37%).

Navigating Pain & Gender Affirmation

Through qualitative analysis, the researchers identified three themes: the fight to legitimize both their pain and gender, the tension between affirming gender and managing pain and the role of gender euphoria as a buffer against pain, and the role of intersecting identities and understanding gender-diverse youths’ pain experiences.

For the TGD youth, the authors observed a common narrative of paternalistic dismissal of their lived experiences based on gender, disability, and age. The patients also described having to educate healthcare clinicians about gender during their times of suffering. They also felt responsible for modifying their gender expression to avoid being misgendered or invalidated.

The analysis also revealed a complicated relationship with pain. Although many pain experiences were discussed, chest binding was the most frequently raised issue in navigating pain and gender affirmation. The TGD also described intersecting identities that influenced their pain experiences, including race, age, socioeconomic status, and neurodiversity.

“Research on the impact of gender-affirming treatment on chronic pain in adolescence is needed to educate providers and mitigate bias,” the authors noted. “Professionals should be knowledgeable of the specific stressors and sources of pain faced by TGD youth, as well as their sources of resilience and strength, so they can appropriately support young people in navigating their care.”