Pelvic Pain on Testosterone: What’s Going On and What Can Help
- Trans Health Research team
- 2 hours ago
- 6 min read
Authors: Kat Walker and Julian Grace.
If you're using testosterone and you've started noticing pelvic pain, you're definitely not alone. One study found more than 1 in 3 trans and gender diverse people using testosterone experience pelvic pain.
It can feel confusing, frustrating, and isolating - especially if this isn't something you've heard of before or didn't expect. So, let’s break it down.
What does pelvic pain feel like?
Pelvic pain can present in a lot of different ways. People often describe it as:
A dull or aching pain.
Sharp, stabbing sensations.
Cramping.
Burning or tingling.
A feeling of heaviness or pressure.
Pain that radiates into the hips, tailbone, or buttocks.
It can happen during everyday things like sitting, standing, going to the toilet - or during things that are supposed to feel good, like sex or orgasm. Or it might happen regularly regardless of the above triggers, and be related to hormonal cycles.
Why is this happening?
There isn’t one clear reason, but here are a few things researchers and clinicians think are going on:
Your pelvic floor muscles might be tight.
Testosterone can increase muscle bulk. When this happens in the pelvic floor, it may cause the muscles to become tight and tender, leading to pain; similar to how your shoulders might feel after a long day of stress.
Your genitals are changing.
Testosterone can also cause genital changes, such as bottom growth (increase in size of the clitoris), thinning of the genital tissues (atrophy), and changes in natural lubrication. These can increase sensitivity in pelvic tissues, resulting in tension and pain in the pelvic floor muscles.
Surgical procedures.
For individuals who undergo gender-affirming surgeries in the pelvic area such as hysterectomy, vaginectomy, metoidioplasty and phalloplasty, post-surgical changes, scar tissue, and healing processes may contribute to pelvic pain.
Avoiding the toilet.
If you have a habit of avoiding public toilets because of safety concerns or lack of inclusive spaces - you're not alone. But regularly “holding it in” can lead to overactive pelvic floor muscles. Repeatedly resisting urges leads to constant tension that can contribute to pain, difficulty emptying your bladder or bowels, and make the muscles harder to relax when you want them to.
Your nervous system plays a role, too.
Pelvic pain is more common in people with a current or past history of PTSD. Trauma can make your body become more protective, and that includes how your pelvic muscles and nerves respond, holding tension.
Hormonal factors (cyclical).
Sometimes pelvic pain can be cyclical, meaning it happens regularly, regardless of other triggers like sexual activity or bowel/bladder issues. In these cases, it’s often associated with other symptoms, like persistent menstruation.
What else can tight pelvic floor muscles cause?
Pelvic floor muscle tension doesn’t only cause pain - it can affect bladder, bowel, and sexual function too. If you are experiencing the following symptoms along with your pelvic pain, it is even more likely the pelvic floor muscles are involved.
● Urgency or frequency with urination.
● Difficulty emptying your bladder fully.
● Recurrent UTI-like symptoms with/without infection.
● Constipation or difficulty with bowel movements.
● Leaks from the front or back (urinary or faecal incontinence).
● Painful penetration or internal exams (both vaginal and anal).
● Difficulty with orgasms or erections.
Jamie’s story
Jamie (he/him) started testosterone about a year and a half ago. After a few months, he noticed a kind of pulling ache around his pubic bone. It got worse during orgasms and would sometimes last for days after. He also started feeling like he needed to pee all the time, and it felt like he could never fully empty his bladder. He also noticed he was becoming constipated.
He brought it up with his doctor, who referred him to a pelvic health physio with experience working with trans people. The appointment started with a conversation about what Jamie was experiencing, and the physio also asked about things like hydration, nutrition, and stress levels. Jamie was then offered the option of either an internal or external examination, and because he was nervous about the prospect of anything internal, the physio assessed the muscles with an external abdominal ultrasound instead. This confirmed that Jamie’s pelvic floor was tight, so they discussed some different options for how to reduce this tension.
The physio explained that there are gentle hands-on techniques that help reduce muscle tension, but these are completely optional and there are many other ways to address the underlying causes. Jamie felt a bit nervous about anything hands-on, so they decided to explore other strategies instead. While they were chatting, Jamie realised he’d been forgetting to drink water when he was at uni, so he and the physio workshopped some practical ways to help increase his hydration. They also went through some stretches and breathing exercises for him to try at home.
By the third appointment Jamie was comfortable enough and saw the benefits in trying some gentle internal work*, to add to the deep breathing and stretches that had already given him some relief. He found this helpful, so the physio taught him similar techniques he could use himself at home. It wasn’t overnight, but things slowly started to feel better — less pain, less tension, easier bladder and bowel habits, and a lot more confidence in his body.
What can help?
There’s good news: pelvic floor tension is treatable, and there are several things you can try, both on your own and with professional support.
Relaxation and self-care.
Find what soothes your body and mind. For some, it’s a warm bath, a full-body massage, yoga, or a heat pack on the pelvis. For others, it’s watching a comfort show or journaling. Stress makes muscle tension worse, so anything that helps you unwind is treatment.
Relaxed diaphragmatic belly breathing.
Try lying on your back with your hands on your lower ribs or belly. Breathe in slowly through your nose and try to direct the air into your lower belly. Imagine your belly and pelvic floor softening and expanding. Breathe out and let everything melt down and release. It might feel subtle, but it’s powerful.
Pelvic stretches.
Gentle stretching can release tight muscles and ease tension. Check out these Easy Stretches to Relax the Pelvis from the Pelvic Pain Foundation of Australia.
See a gender-informed pelvic health physiotherapist.
Pelvic floor physios are physiotherapists who have done an extra post graduate training to specialise in pelvic health. They help people to understand their anatomy and symptoms, identify areas of tension, and develop strategies to help relax and care for the pelvic floor based on your unique health needs.
Ask about topical treatments.
Testosterone reduces oestrogen levels in local tissues. Regardless of sex assigned at birth, every body needs a little oestrogen in the right places to stay healthy and comfortable. Talk to your GP or specialist about topical oestrogen creams or other treatments that might help irritation in the genital area.
Chat to your doctor.
If your pelvic pain is cyclical (e.g. monthly), and particularly if you’re still getting periods despite being on testosterone, it’s a good idea to talk to your hormone prescriber (usually a GP, endocrinologist, or sexual health physician). Sometimes changing the method or dosage of your testosterone can help with this, and there are also other medications which can stop unwanted periods.
You deserve to feel comfortable in your body
Pelvic pain is real. It’s common. And it’s treatable.
If you’re dealing with pain, you deserve care that sees and supports you.
If you're not sure where to start, talking through your symptoms with a gender-informed health professional can be a great first step. The AusPATH provider list includes some options for trans inclusive practitioners, and we have some other directories listed here . If you can't find an option in your area, then a referral service like QLife or a local peer group might be able to point you in the right direction.
*Internal soft tissue techniques performed by a pelvic floor physio can often be helpful, but they're completely optional. This involves the physio gently massaging the muscles through inserting a finger into the vagina or anus. You’re always in control of what happens in your sessions. If internal work feels too uncomfortable or just not right for you, that’s okay. Pelvic floor physios can teach you how to do these techniques yourself at home, in your own time and space, if that feels safer or more comfortable. Often understanding contributing factors to your pain, belly breathing and stretches is enough to see improvements too.
