Background & Aims

Transgender (Trans) is a generic term of the LGBTQIAP+ acronym (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Pansexual, and more), representing people whose gender identity differs from their assigned sex at birth. To align the body to their gender identity, transgender people may need gender-affirming hormone therapy (GAHT) as an alternative. GAHT alters sex steroid profiles, inducing masculine characteristics in trans men (testosterone) and feminine characteristics in trans women (estrogen). The literature suggests a correlation between sexual dimorphism and a higher prevalence of pain conditions, such as temporomandibular disorders (TMD), in cisgender women, potentially due to estrogen levels and social stressors. Considering minority stress, hormone use, and the high rates of violence against the trans community in Brazil, the present study aims to investigate TMD, anxiety symptoms, and facial changes after initiating GAHT.

Methods

The sample consisted of trans women and trans men aged 18-55 years, recruited from the Gender Incongruence Outpatient Clinic of the Department of Gynecology and Obstetrics at the Faculty of Medicine of Ribeirão Preto, University of São Paulo (HCFMRP-USP). Participants responded to a semi-structured sociodemographic questionnaire, including a question about the frequency of dental visits. The diagnosis of temporomandibular disorder and orofacial pain was based on the ‘Diagnostic Criteria for Temporomandibular Disorders’ (DC/TMD). To evaluate generalized anxiety, the GAD-7 questionnaire was employed. Additionally, three-dimensional stereophotogrammetry (3D) analysis was used to examine changes in facial soft tissues. Participants were evaluated before hormone initiation and followed up at three and six months post-initiation. Statistical analysis involved both quantitative and qualitative descriptive statistics.

Results

A total of 48 trans were recruited, with 43 accepting participation (22 trans men, 21 trans women). On average, participants reported 34 months without a dental check-up. Trans men exhibited the highest TMD prevalence(75%), mainly with local myalgia and disk displacement, with half-experiencing painful TMD. GAD-7 scores showed mild symptoms in 42.2%, with trans women having a higher percentage of moderate symptoms(38.1%). Before GAHT, 69.9% showed TMD signs, reducing to 48.4% after 3 months, with painful TMD to 21.1%. The GAD-7 for those with minimal symptoms increased to 40.6% and the percentage of women with moderate symptoms decreased to 25%. After 6 months, 41.6% had TMD signs, DDCR cases remained, arthralgia and myalgia decreased(20.8%). Trans men demonstrated increased facial volume after 3 months, particularly in four of the 5 predefined areas. After 6 months, there was an increase in all 5 areas for trans men, especially in the jaw. Trans women exhibited less notable increases.

Conclusions

The results reveal the impact of gender-affirming hormone therapy (GAHT) as a whole on reducing the prevalence of Temporomandibular Disorders (TMD), particularly in painful cases, among transgender people. The association between this reduction and a decrease in anxiety symptoms suggests a complex interplay within the biopsychosocial aspects of individuals undergoing GAHT. Emphasizing the significance of these factors, there is a need for integrated healthcare approaches for transgender people, recognizing the interconnected nature of mental health and physical changes with pain. Additionally, the volumetric changes, especially in trans men, underscore the influence of GAHT on facial characteristics. These findings emphasize the necessity of spreading awareness about these subjects and the need for inclusive attention from healthcare professionals.

References

Berger M, Szalewski L, Bakalczuk M, Bakalczuk G, Bakalczuk S, Szkutnik J. Association between estrogen levels and temporomandibular disorders: a systematic literature review. pm. 2015;4:260–70.

Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. International Journal of Transgenderism. agosto de 2012;13(4):165–232.

Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 1º de novembro de 2017;102(11):3869–903.

Lerri MR, Romão APMS, Santos MAD, Giami A, Ferriani RA, Lara LADS. Clinical Characteristics in a Sample of Transsexual People. Rev Bras Ginecol Obstet. outubro de 2017;39(10):545–51.

Robinson JL, Johnson PM, Kister K, Yin MT, Chen J, Wadhwa S. Estrogen signaling impacts temporomandibular joint and periodontal disease pathology. Odontology. abril de 2020;108(2):153–65.

Presenting Author

Laís Valencise Magri

Poster Authors

Alex Mélo

MS student

University of São Paulo

Lead Author

Lais Magri

Universidade de São Paulo

Lead Author

Lúcia Lara PhD

University of São Paulo

Lead Author

Melissa Melchior Ms

University of São Paulo

Lead Author

Manoel Sousa-Neto PhD

University of São Paulo

Lead Author

Jardel Mazzi-Chaves PhD

University of São Paulo

Lead Author

Topics

  • Gender/Sex Differences