# Lower Urinary Tract Symptom Scores Among Patients Presenting for Gender Affirming Orchiectomy: An Exploratory Analysis

## TL;DR

This study explores urinary symptoms in transgender patients seeking orchiectomy, finding that mental health history may influence how symptoms are experienced more than symptom severity alone.

## Contribution

The study is the first to explore urinary symptom bother in gender-diverse patients and links it to mental health history rather than hormone therapy.

## Key findings

- Urinary symptoms in gender-diverse patients were generally mild, with frequency and nocturia most common.
- Patients with a history of anxiety, depression, or bipolar disorder reported higher symptom bother scores.
- Mental health history may influence how urinary symptoms are experienced and reported, beyond symptom severity.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Urinary symptoms and related distress can affect daily functioning, healthcare utilization, and quality of life in a growing transgender and gender-diverse population.Mental health conditions, which are highly prevalent in this population, may meaningfully shape how physical symptoms are experienced and reported.

Urinary symptoms and related distress can affect daily functioning, healthcare utilization, and quality of life in a growing transgender and gender-diverse population.

Mental health conditions, which are highly prevalent in this population, may meaningfully shape how physical symptoms are experienced and reported.

Public health significance—Why is this work of significance to public health?
This study demonstrates that symptom-related quality of life burden may be linked more to mental health history than to hormone regimen or symptom severity alone.These findings suggest that standard clinical metrics may underestimate patient distress in gender-diverse populations.

This study demonstrates that symptom-related quality of life burden may be linked more to mental health history than to hormone regimen or symptom severity alone.

These findings suggest that standard clinical metrics may underestimate patient distress in gender-diverse populations.

Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers in public health?
Multidisciplinary, gender-affirming care models should address mental health alongside urinary symptoms to improve patient-centered outcomes.There is a need for validated, transgender specific tools to measure urinary symptoms and related quality of life in transfeminine populations.

Multidisciplinary, gender-affirming care models should address mental health alongside urinary symptoms to improve patient-centered outcomes.

There is a need for validated, transgender specific tools to measure urinary symptoms and related quality of life in transfeminine populations.

Current literature on baseline voiding function in gender-diverse patients assigned male at birth (AMAB) is limited. We conducted a retrospective analysis of patients presenting for gender-affirming orchiectomy consultation between 2021 and 2024 who completed the American Urological Association symptom score (AUA-SS) questionnaire to characterize baseline urinary symptoms and identify factors associated with symptom-related bother. Demographics, hormone therapy characteristics, and comorbidities were collected. Bother score was analyzed as both an ordinal variable (score 0 = “delighted” to 6 = “terrible”) and dichotomized (no bother = “delighted” or “pleased” and some bother = “mostly satisfied” to “terrible”). Twenty-six patients met the inclusion criteria, with a median age of 28 years. Overall symptom burden was low (median AUA-SS 4, IQR 2–7.3), with frequency and nocturia reported most commonly. Despite mild symptoms, most patients did not select the lowest possible bother score (“delighted”). Total AUA-SS and bother were not significantly associated with hormone therapy type or duration. In contrast, those with a documented history of anxiety, depression, or bipolar disorder had significantly higher bother score compared to those without (mean rank 15.3 vs. 9.6, p = 0.04). In this single-center cohort, urinary symptoms were generally mild among AMAB patients seeking gender-affirming orchiectomy. Psychiatric history was associated with a higher bother score, though this relationship was no longer significant when bother was dichotomized. These findings suggest behavioral factors may influence how urinary symptoms are experienced and reported in this population. These findings are exploratory and warrant validation in larger cohorts.