Reducing Dysphoria During Pubertal Examination: Determining if Transgender and Gender-Diverse Young People Designated Male at Birth Can Accurately Measure Testicular Volumes with a Prader Orchidometer

Purpose: This study queried if young transgender and gender-diverse (TGD) individuals designated male at birth (DMAB) could accurately self-assess testicular volume (TV) for pubertal monitoring. Methods: This was a cross-sectional study of self-identified TGD young people DMAB (age 9–18 years) who required assessment of pubertal status between May 2021 and October 2022. TV measurements with Prader orchidometers were used, followed by a satisfaction survey using questions with ordinal responses. Analytics with weighted kappa coefficients and percent agreement compared clinician exams and self-exams for TV (and corresponding Tanner stage). Descriptive statistics were used for survey items and patient demographics. Results: There was a 20% perfect agreement between self-exam and clinician exam among the 30 participants sampled (mean age = 13.7 years, mean left TV = 12.8 mL [Tanner 4], mean right TV = 12.4 mL [Tanner 4]). When measurements disagreed, 47% were off by one orchidometer bead, with 60% overestimating by one bead. There was moderately high inter-rater reliability between self-exam and clinician exam for TV (kappa w = 0.57, 95% confidence interval [CI]: 0.48–0.65) and for Tanner stage (kappa w = 0.59, 95% CI: 0.49–0.69). When surveyed, 43% of participants preferred self-exam and 53% reported positive experience in the study. Conclusions: Most participants measured TV within one bead size or Tanner stage of the clinician, with 20% perfect agreement and moderately high inter-rater reliability. Participants reported acceptability of self-exam. Participants tended to overestimate testicular size, and measurements were inaccurate for prepubertal TV sizes. Therefore, self-exams should not be used to differentiate between prepuberty and puberty.