Chronic pain in transgender and gender-diverse youth: a biopsychosocial perspective

Chronic pain-including both chronic primary pain (e.g., headaches, widespread musculoskeletal pain, abdominal pain) and chronic secondary pain associated with other health conditions-represents a significant yet underrecognized health concern among transgender and gender-diverse (TGD) youth. While data on the prevalence of chronic pain in TGD youth remain limited, early studies indicate higher rates compared to their cisgender peers, highlighting the need for understanding factors underlying this co-occurrence. Chronic pain arises from a complex interplay of neurobiological, psychological, and social factors, and its heightened prevalence in TGD youth may be driven by the compounded impact of biopsychosocial stressors that disproportionately affect this group. This review summarizes neurobiological vulnerabilities, psychosocial factors, and societal and systemic barriers that may contribute to increased risk of chronic pain in TGD youth. We also examine the role of gender-affirming care in addressing these biopsychosocial vulnerabilities and explore its potential to alleviate some of the factors associated with chronic pain. Additionally, we identify critical gaps in the current body of research, such as the need for longitudinal studies and deeper exploration of the effects of medical interventions like pubertal suppression and exogenous hormones on chronic pain mechanisms and outcomes. By synthesizing the available evidence, we aim to guide future research and offer actionable recommendations to enhance clinical care and support for TGD youth experiencing chronic pain.