To investigate the prevalence of lower urinary tract symptoms (LUTS) and genital symptoms among transgender men in Japan, and to evaluate their impact on daily life, including limitations resulting from concerns about toilet accessibility.
We conducted a cross-sectional, single-center survey of assigned-female-at-birth individuals aged 16 years or older who had been approved for gender-affirming hormone therapy at our gender center. A self-administered questionnaire included the Core Lower Urinary Tract Symptom Score (CLSS), vaginal and urethral symptom items, toilet use outside the home, preferences regarding male urinals, and activity restriction related to toilet access. Data were analyzed descriptively, and multivariable logistic regression analyses were performed.
Data from 322 participants (median age 33 years) were analyzed. Overall, 80% reported at least one LUTS, 46% reported at least one bothersome symptom, and 14% had a CLSS global quality-of-life (QOL) score of ≥ 4. Vaginal symptoms occurred in 13% of participants, and 2% reported post-micturition leakage. Most participants (62%) did not use male urinals but wished to use them. Activity restriction due to toilet-related concerns, defined as avoiding or limiting activities such as travel, shopping, or going to the cinema, was reported by 20%, and higher total CLSS was associated with both activity restriction and poor urinary-related QOL.
LUTS and genital symptoms are common in young transgender men, and greater LUTS burden is linked to urinary-related QOL impairment and toilet-related activity restriction. These findings highlight the need for targeted clinical care and improved accessibility of public toilets for transgender men.
International journal of urology : official journal of the Japanese Urological Association. 2026 Aug [Epub]
Tomoko Kobayashi, Takatoshi Moriwake, Yusuke Tominaga, Nariaki Ozaki, Satoshi Horii, Ichiro Tsuboi, Kasumi Yoshinaga, Tomoaki Yamanoi, Tatsushi Kawada, Takuya Sadahira, Takehiro Iwata, Satoshi Katayama, Shingo Nishimura, Kensuke Bekku, Yuko Matsumoto, Miyabi Inoue, Masami Watanabe, Ayano Ishii, Toyohiko Watanabe, Motoo Araki
Department of Urology, Okayama University Hospital, Okayama, Japan., Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan., Miyakekai Good-Life Hospital, Hiroshima, Japan., Miyabi Urogyne Clinic, Okayama, Japan., Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, Japan.