Shifting hormones, shaping health: Gender-affirming therapy & oral care

Background: Gender-affirming hormone therapy (GAHT) is a critical aspect of transgender healthcare. Little is known about the effects of GAHT on oral health, which may be influenced by immune modulation, salivary composition shifts, and microbial dynamics as a result of hormone use. Aim: To clinically, biochemically and microbiologically assess changes in oral health of transgender persons during the first year of GAHT. Methods: Twenty-one transmasculine and eighteen transfeminine persons took part in the study. Participants were followed for 12 months. Every 3 months, participants underwent an oral checkup, including full oral assessment and light and fluorescent photos of gums and tongue, donated saliva and filled in a questionnaire over oral health self-perception and dry mouth. Salivary samples were later analyzed for certain proteins and for microbial composition using 16S rRNA gene amplicon sequencing. N-way Partial Least Squares (NPLS) models were used to perform a supervised analysis of the variation in the data associated with GAHT. Results: GAHT induces transient disruptions in salivary composition and microbial communities during the first six months, followed by stabilization by twelve months. Differences in microbial composition were observed between transmasculine and transfeminine persons, suggesting that GAHT exerts distinct effects on oral microbiota depending on hormonal regiments, with potential implications for periodontal health. Discussion: This clinical longitudinal study investigated for the first time the oral health of transgender individuals undergoing GAHT during the first year of transition. These results underscore the importance of tailored dental care during early stages of GAHT and contribute to a more comprehensive understanding of how systemic hormonal treatments can impact oral physiology. This work supports the development of more inclusive healthcare approaches that address the unique needs of transgender populations.