Chronic Pain and the Transgender Community: Inclusive Care for Better Outcomes
Chronic pain affects millions of people globally, limiting quality of life, mobility, and mental wellbeing. While chronic pain can affect anyone, some communities face additional and unique challenges in both the causes of their pain and the barriers they face in accessing care. One such community is the transgender (trans) community.
Trans individuals living with chronic pain often experience a myriad of physiological, psychological, and social factors that impact their health. As healthcare providers, it’s essential we understand these specific challenges in order to deliver safe, affirming, and effective care.
Gender-Affirming Practices and Musculoskeletal Health
Many trans people engage in gender-affirming practices as part of their transition. While these practices are vital for mental health and identity alignment, they may also contribute to chronic pain or musculoskeletal (MSK) concerns.
Chest Binding and Pain
Binding the chest, commonly practiced by transmasculine individuals to create a flatter appearance, can cause:
Back and chest pain
Muscle strain
Restricted breathing and posture-related discomfort
When performed improperly or for extended periods without breaks, binding may exacerbate existing MSK issues or contribute to new sources of pain. This makes it important for healthcare professionals to sensitively inquire about binding habits and provide guidance on safer techniques where needed.
Tucking and Pelvic Pain
Tucking is another gender-affirming practice used by some transfeminine individuals to create a smoother pelvic appearance. However, it can result in:
Pelvic floor tension
Testicular, penile, or groin pain
Aggravation of pre-existing discomfort
Prolonged tucking or using unsafe methods can amplify chronic pelvic pain symptoms. Understanding this can help practitioners tailor rehabilitation or pain management plans accordingly.
Hormone Replacement Therapy (HRT) and Pain Sensitivity
HRT is a key part of medical transition for many transgender individuals, but hormonal changes can also:
Alter pain perception and tolerance
Trigger symptoms such as headaches, musculoskeletal aches, and chest tenderness
Interact with pre-existing conditions or pain pathways
While HRT has a wide range of benefits for gender dysphoria and mental health, its effects on the body are multifaceted and should be considered in chronic pain management strategies.
Discrimination in Healthcare: A Barrier to Pain Management
Discrimination remains a significant obstacle for trans individuals seeking care for chronic pain. Studies show that around 65% of trans people report experiencing discrimination from healthcare providers. This mistreatment can take the form of:
Misgendering
Dismissal of symptoms
Lack of knowledge around trans-specific health concerns
These negative experiences often lead to avoidance or delay in seeking care — particularly for non-life-threatening issues like chronic MSK pain. For those living with pain every day, this can result in worsening symptoms and prolonged suffering.
Why Inclusive, Informed Care Matters
The disparities in transgender healthcare are often linked to a lack of training among providers. Without education on gender-affirming practices and their physiological effects, well-meaning clinicians may miss important pieces of the clinical picture.
As MSK health professionals — whether in chiropractic, physiotherapy, or osteopathy — we have a responsibility to:
Provide a safe, respectful space for all patients
Ask informed, compassionate questions about binding, tucking, or HRT when relevant to pain or injury
Be open about what we know — and willing to learn more where we don’t
Offer tailored strategies that consider the unique lived experiences of trans individuals
Inclusive care isn’t just ethical — it’s effective. When patients feel seen, respected, and heard, they’re more likely to engage in care and achieve better outcomes.
Our Commitment
At Proactive Chiropractic & Sports Injury, we believe that everyone deserves access to care that respects their identity and understands their body. We are committed to delivering trans-inclusive, evidence-informed chronic pain care that addresses both the physical and emotional components of pain.
If you’re a member of the LGBTQ+ community looking for affirming MSK support, our team is here to help.