Reproductive and genital health in transmasculine people
Addressing Testosterone-Associated Genital Symptoms, Testosterone associated vaginitis, Bleeding and Pregnancy Beyond the Binary
Transmasculine and non-binary people may experience significant reproductive and genital health needs that remain poorly recognised within UK healthcare.
Testosterone-associated vulvovaginitis (TAV) is an under-recognised cause of genitourinary symptoms, with a reported five-year prevalence of approximately 64–78% among transmasculine people receiving testosterone. Vaginal bleeding is also common and may be distressing, yet there is currently limited trans-specific evidence and no universally accepted, evidence-based approach to investigation and management.
This body of work brings together clinical best-practice development and qualitative research to examine the intersecting clinical, reproductive and structural challenges experienced by transmasculine and non-binary people.
A BASHH Gender and Sexual Minorities Special Interest Group working group, reviewed the available evidence and developed a first-in-world best-practice statement for TAV. In the absence of robust trans-specific studies, recommendations draw on relevant guidance concerning menopause-associated and desquamative vaginitis. TAV should be considered in transmasculine patients using testosterone who present with genitourinary symptoms; we discuss assessment, examination and management.
Alongside this, a proposed clinical pathway for testosterone-associated bleeding highlights the importance of considering pregnancy, genital tract infection, cervical pathology, endometrial disease and other causes. Appropriate investigation should be guided by symptoms, anatomy and individual risk. Bleeding may also prompt review and optimisation of gender-affirming treatment. Endometrial cancer, although uncommon, must not be overlooked.
Qualitative research involving trans and non-binary migrants in the UK further demonstrates how migration status, gender identity and race intersect within maternity care. Using reproductive justice and intersectional feminist frameworks, the research explores experiences of antenatal and postnatal services, encounters with healthcare professionals and strategies used to navigate systems shaped by immigration governance and cisnormative assumptions.
Together, these findings highlight the urgent need for national, evidence-informed and inclusive guidance addressing TAV, bleeding, fertility, pregnancy, screening and maternity care. Such guidance should combine clinical safety with culturally competent, trauma-informed and non-discriminatory practice. Robust trans-specific research and studies of marginalised populations, is urgently required to strengthen the evidence base and improve long-term reproductive and genital health outcomes.
Speaker
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Ruth Bond
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Joe Smith
I am a consultant physician with a background in sexual health and HIV, and medical gender specialist at the Laurels Gender Identity Clinic, Exeter, UK. I am also a transmasculine person of lived experience and advocate/activist. Aside from my clinical duties, I am the head of research and development at the Laurels, and teach at undergraduate and postgraduate level across the MDT spectrum on LGBTQ+ social issues, improving medical care for trans people and reducing health inequalities. -
Diya Padiyar
Diya Paresh Padiyar is a researcher in Gender Studies and English at Lancaster University, with research interests spanning trans and non-binary healthcare, reproductive justice, migration, gender, and health inequalities. Originally from Goa, India, she holds a BA in English from Goa University, where she graduated as Valedictorian, and recently completed her MA in Gender Studies and English at Lancaster University, where she was also a recipient of the Lancaster Award. Her MA dissertation, Pregnancy Beyond the Binary: Trans and Non-Binary Migrant Experiences of UK Maternity Healthcare, explores how migration status, race and gender identity intersect to shape trans and non-binary migrants’ experiences and expectations of pregnancy and maternity care in the UK. Drawing on qualitative interviews and frameworks of reproductive justice, intersectionality and situated knowledges, the research examines barriers to care, cisnormative healthcare structures, and how individuals anticipate and navigate reproductive healthcare systems. Alongside her postgraduate research, Diya is contributing to a clinical research project examining the assessment and management of abnormal vaginal bleeding among trans men and non-binary people assigned female at birth who use gender-affirming testosterone. Her work includes evidence synthesis and contributing to a scoping review of existing clinical literature. Diya is particularly interested in interdisciplinary, community-informed and advocacy-oriented approaches to trans healthcare, reproductive health and migrant experiences, and in bridging social-science research with clinical practice and policy. Her forthcoming contribution, “Advocacy”, to the Encyclopedia of Queer Media reflects her wider interest in queer media, representation and advocacy. She has presented her research across academic and public-facing settings, with her dissertation research awarded Third Place at Lancaster University’s Postgraduate Research Conference in 2026. At BAGIS, Diya will present findings from this research, bringing an intersectional reproductive justice perspective to conversations around inclusive reproductive and maternity healthcare.