Trans people taking testosterone to help them change gender have been warned of the "consequences" of their actions after a study revealed that those taking the hormone started suffering "postmenopausal" health problems as early as their 20s.
Researchers found that 95 per cent of patients taking testosterone in order to "transition" from female to male developed problems with muscles in their pelvic floor - colloquially, their undercarriage - which medical professionals would usually only expect to see in women after the menopause.
The study found almost nine in 10 participants displayed symptoms like incontinence and bed-wetting, while 74 per cent suffered bowel issues like constipation and being unable to hold in stools or wind.
Just over half suffered from sexual dysfunction, the study found, with just under half having an "orgasm disorder", while a quarter suffered from pain during sex.
Researchers found that 95 per cent of patients taking testosterone in order to "transition" developed muscle problems in their pelvic floor
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Researchers said the rate of urinary incontinence was around three times higher in transgender men than "cisgender" women, affecting around 25 per cent compared to eight per cent, respectively.
More trans men studied by researchers were found to suffer from frequent urinating - including during the night - burning sensations, hesitancy, urgency and difficulty in going, while others had issues defecating.
Elaine Miller, a pelvic health physiotherapist and member of the Chartered Society of Physiotherapy, warned of the impact on young people's lives of the drugs, with a third of those surveyed being students.
Miller said: "A lot of women are absolutely fine until the menopause and then they start to get leaky... That appears to be exactly the same trajectory for female people who take cross-sex hormones, but there hasn't been much in the way of research.
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The LGB Alliance's Kate Barker pointed to the Cass Review as justification for their stance on hormone therapy
PA"The impact a bit of leaking has on these young people's lives is huge... It really needs to be properly discussed within gender clinics because I would expect that almost 100 per cent of female people that take cross-sex hormones will end up with these problems."
On the NHS, women who begin the menopause prematurely can be offered Hormone Replacement Therapy (HRT) in order to help maintain their oestrogen levels.
But people looking to gender transition by taking testosterone may run the risk of accelerating the problems that reduced oestrogen can present.
Kate Barker, the chief executive of gender-critical campaign group the LGB Alliance, said her organisation had "consistently spoken out about the damage done by these experimental surgeries, the overwhelming majority of which are carried out on LGB [lesbian, gay and bisexual] people.
"Our annual conference has heard testimony from detransitioners who live every day with the consequences of actions they took when they were very young - sometimes in their teens - including permanent sterilisation and loss of sexual function."
Barker pointed to the Cass Review as justification for the LGB Alliance's concerns; the review prompted the NHS to put the provision of hormones to under-18s on hold amid a range of recommendations on gender identity services for children and young people.
This study's authors - headed up by the Brazilian Federal University of Pernambuco's Lyvia Maria Bezerra da Silva - said the findings "showed a high frequency of at least one of the pelvic floor dysfunction symptoms".
But researchers called for further research into impact of testosterone as a transitioning tool as the "long-term effects are still unknown".