(70) Intrauterine Device Experiences in Gender Diverse Adolescents and Young Adults: A Multisite Study

Background: To our knowledge, no studies have explored the intrauterine device (IUD) experience of gender diverse (GD) adolescents and young adults (AYA) who are and are not receiving gender-affirming testosterone therapy. We describe demographic characteristics, procedural outcomes, and continuation rates of these two groups of AYA seeking IUDs, and compare this experience to their cisgender peers.

Methods: This retrospective cohort study included AYA age 13-26 years seeking an IUD from 1/1/2020 to 12/31/2022 at 4 Adolescent Medicine clinics. GD was defined as a gender identity other than female and/or reporting transgender/gender dysphoria at the time of insertion. Descriptive statistics characterized the patient populations. Cochran-Mantel-Haenzel tests compared measures between groups. Kaplan-Meier and Cox proportional-hazard modeling assessed continuation rates. IRB approval was obtained at each site.

Results: Of 807 attempted IUD insertions, 744 (92%) were in cisgender and 63 (7.8%) in GD individuals, of whom 20 (32%) were on gender-affirming testosterone therapy at the time of insertion. There was no significant difference by IUD indication (p=0.90) between the 3 groups, with the majority seeking menstrual management alone or in combination with contraception; few desired contraception only.

IUD insertion was successful in 672/744 (90%) cisgender AYA compared to 16/20 (80%) GD individuals on testosterone and 40/43 (93%) GD individuals not on testosterone. Procedural success did not differ between cisgender and GD individuals, regardless of testosterone use (p=0.10). No GD patients on testosterone required cervical dilation during insertion, while 3 (7%) GD patients not on testosterone and 65 (8.7%) cisgender patients required dilation. Unsuccessful insertions were more likely to have required dilation (43.6% of unsuccessful insertions versus 6.3% of completed insertions, p< 0.01).

The one-year IUD continuation rate did not differ between groups: cisgender 87%, GD on testosterone 78%, and GD not on testosterone 93% (p=0.10). However, the three-year IUD continuation rate differed significantly between cisgender (81%), GD on testosterone (78%), and GD not on testosterone (87%) (p < 0.005).

Conclusions: Compared to cisgender peers, GD AYA experienced similarly high rates of successful IUD insertion, regardless of whether participants were on testosterone. While one-year continuation rates were high, and did not differ between groups, GD AYA on testosterone had a lower three-year continuation rate compared to the other groups.