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.