These sexual differences found for severity, duration, and alleviation of pain suggest the presence of a sexually dimorphic mechanism underlying chronic pain. Females show a greater incidence of chronic pain conditions including headache, osteoarthritis, rheumatoid arthritis, irritable bowel syndrome, and fibromyalgia 22;45;63. Prior studies show that the serotonin transporter (SERT) is increased in the nucleus raphe magnus (NRM) in models of chronic pain, and that blockade of SERT in the NRM reduces hyperalgesia. It may also be referred to as 'myofascial trigger point therapy' by others. For this reason, myofascial therapy is sometimes referred to as 'myofascial release' therapy. Other conditions treated by myofascial release therapy include Temporo-Mandibular Joint (TMJ) disorder, carpal tunnel syndrome, or possibly fibromyalgia or migraine headaches. There are a number of conditions and symptoms that myofascial release therapy addresses.
However, more recent studies show that testosterone also plays a role in the sexual dimorphism of pain. Sex differences in the prevalence of pain conditions are not present in children until puberty suggesting a role for sex hormones 6;30. Sex differences are present in both the symptomology and prevalence of chronic pain conditions.
Interestingly, females that were taking exogenous hormones in the context of oral contraceptive therapy experienced pain to a lesser intensity compared to females that were on a natural cycling of hormones, suggesting the big impact that fluctuations have on pain perception . Sex hormones play a different role in many of the pain-related conditions that affect biological males and females as well as transgender patients. In females at reproductive age that are not receiving oral-contraceptive therapy or other forms of exogenous hormones, pain is typically at the highest intensity following a sudden drop in estradiol, which typically takes place in the middle (days 13–15) of the menstrual cycle . Literature has shown inconsistent results when considering the effects of estradiol on pain perception in females. Based on physiologic concepts, it is expected that males exposed to long-term estrogen supplementation have a different pain perception and modulation compared with females exposed to prolonged androgen therapy.
This experiment tested if testosterone administration could reverse the sex-dependent effects observed in pain behavior between intact males and orchiectomized males and females. We hypothesized that females would show a greater increase in SERT in the nucleus raphe magnus in the activity-induced pain model when compared to males. In contrast, transgender females complaining of breast pain are more likely to present with hormone-induced tissue changes, such as gynecomastia. Although estrogen fluctuations in females was considered a trigger for pain and increased pain intensity, perhaps estrogen hormone replacement in these patients may help prevent musculoskeletal pain by providing that protective layer that they previously had prior to menopause.
Incorporating practices like stretching, relaxation exercises, and posture correction can help maintain the benefits of MFR therapy. MFR therapy is most effective when integrated into a broader pelvic health care plan. Future research should focus on standardized protocols and long-term outcomes to better understand the therapy's efficacy. However, anecdotal evidence and clinical reports suggest significant benefits for pelvic pain and dysfunction.
Changes in pain perception and pain-related chronic conditions have been most frequently evaluated as part of the quality-of-life assessment. This may be due to many factors, one of which being that cervical screening in transgender men may trigger gender dysphoria and expose the natal anatomy of these patients, and thus making them uncomfortable during the exam. However, recent studies in transgender patients also show an increased frequency of complications, including skin excess and ptosis, abrasions, infection, and pain .