Observational studyClinical oral investigations2025
Three-dimensional facial volumetric changes in transgender individuals induced by gender-affirming hormone therapy: a stereophotogrammetric assessment.
Observational study in Clinical oral investigations, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate facial volumetric changes in transgender (trans) individuals undergoing gender-affirming hormone therapy (GAHT) using stereophotogrammetry (Vectra H1).
methodsThis longitudinal observational study enrolled a total of 30 participants: 17 self-identified as transgender men, one as a non-binary transmasculine individual, and 13 as transgender women. All were receiving care at the Gender Diversity Gynecology Clinic (GDIG) of the Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo (HCFMRP-USP). Facial scans were obtained at four time points: baseline (T0), 3 months (T1), 6 months (T2), and 12 months (T3) after initiation of GAHT. Volumetric analyses focused on five facial regions: mandibular, maxillary, frontal, mental (chin), and labial. Statistical analysis included the Mann-Whitney U test to compare groups and Spearman's correlation to assess associations between weight variation and facial volume changes. A multivariate analysis of covariance (MANCOVA) was conducted with facial volumetric regions as dependent variables, followed by post-hoc univariate ANCOVA.
resultsGender had a significant global multivariate effect on the combined set of facial volumes at all time points (p < 0.001). Trans men showed a consistent and significant increase in total facial volume and in all five regions over time, particularly in the lower third of the face. The pattern of change was rapid and homogeneous, with the most notable increases observed between T0 and T1 and sustained through T3. In contrast, trans women exhibited more variable and localized changes. Increases in maxillary, frontal, and labial volumes were observed at T1 and T2, with more widespread volume gains in four of five regions at T3, suggesting gradual adipose redistribution induced by estradiol.
conclusionGAHT produces consistent global differences in facial volumetric patterns between trans men and trans women, with the most pronounced region-specific changes observed in total facial and mandibular volumes. Testosterone promotes a faster and more uniform masculinization of facial structures, while estrogen associated with an antiandrogen leads to more subtle and regionally distributed feminization over time. These findings demonstrate the effect of GAHT in promoting facial characteristics aligned with gender identity in transgender individuals, with distinct patterns of change observed between transgender men and women.
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