J. K. Rowling and the Dreaded Pee Squirts
We’re talking about the importance of gynecological care and pelvic floor health and no third-rate children’s author can stop us.
by Evan Urquhart
Do you want to talk about pee squirts? Well me neither, but the Telegraph and a well-known children’s author want to talk about pee squirts so I guess we’re talking about pee squirts today.
It has long been believed that trans men may have a higher frequency of certain urinary symptoms including nocturia (getting up to pee in the night) and incontinence (aka peeing yourself, such as an occasional pee squirt on a sneeze or a cough). Whether this is true, and if so why, is still unknown, and a small Brazilian study of 68 transgender men on testosterone by da Silva et al. is unlikely to shed very much light on the question.
It did allow the Telegraph to insinuate that trans men are going around peeing and pooping themselves all the time, and to describe the issues as “‘postmenopausal’ problems” as a means of misgendering them. This misgendering impulse was then doubled down on by Rowling, whose tweet of the article called the trans men in the study “young women” (the study participant’s mean age was 28).
Well done, everyone.
The actual study itself is an example of the type of research the trans community could use more of, and as such I’m loath to be too hard on its methods. This is the sort of research that can help doctors of trans patients understand common complaints and provide the trans community with better medical care.
The authors surveyed 68 trans men on testosterone about a range of symptoms, most but not all of which related to pelvic floor health. The most common symptoms reported were also the most minor: Over forty percent of the sample said they had trouble reaching orgasm with a partner, 47 percent said at times they strained when they took a poop, 46 percent reported experiencing constipation, and 42 and 47 percent said they had a sensation of incomplete emptying of their bladders and “post void dribbling” respectively.
In addition to a bunch of constipation, a smaller number of the study respondents had the infamous pee squirts or other symptoms under the umbrella of “urinary incontinence,” symptoms which the Telegraph and Rowling made much of. The paper itself claimed to find incontinence in 23.5 percent of their respondents (or 16 out of 68), which they said was a higher frequency than studies with cisgender women, which they put at 8.7 percent. However, a perusal of the literature on the topic made it difficult to know where that 8.7 percent figure was coming from. The da Silva study cited this paywalled paper whose results seem to indicate finding a much, much higher prevalence of incontinence among cis women than that.
Another study of incontinence among women in the United States found that over 60 percent reported incontinence, with 32 percent having symptoms at least monthly. All in all, while testosterone therapy has been reasonably hypothesized to contribute to incontinence symptoms such as pee squirts, the actual research doesn’t seem to bear that out yet. There’s also a possible confounding effect from behavior, as trans people including trans men are particularly likely to avoid public restrooms, and to intentionally dehydrate themselves in order to facilitate this. Both dehydration and holding it in for long periods of time are believed to worsen bladder symptoms such as incontinence and UTI.
One clear thing the research does show is that the sorts of symptoms reported in the da Silva et al. study are quite common among women and men, even if they’re more common among trans men (though, again, this is hypothesized but not actually clearly shown in the research thus far).
It’s important to note that the symptoms found by da Silva et al. are generally very treatable. Trans men are notorious for avoiding doctor visits, particularly gynecological visits which can exacerbate dysphoria while also carrying a high risk of discrimination by medical providers who are unfamiliar and uncomfortable with trans men’s bodies and needs. However, the issues here have easy fixes: Pelvic floor exercises such as Kegels can reduce or eliminate embarrassing urinary symptoms, better diet and exercise can reduce constipation, and vaginal dryness and pain during intercourse can be treated with topical estrogen creams.
The misgendering and shaming from anti-trans news outlets are unlikely to help trans men feel comfortable enough to seek the help they need, and instead will likely further exacerbate the shame, fear, and embarrassment that keeps trans men avoiding doctors like the plague. But, luckily, the issues mentioned are genuinely so minor it’s hard to worry that much. No one ever died of pee squirts. (But do your Kegels, guys.)
Evan Urquhart is the founder of Assigned Media and an incoming member of the 2024-2025 Knight Science Journalism fellowship class at MIT.