Epidemiology and clinical outcomes of filler-related complications among transgender women in Mexico

Abstract Filler-related complications (FRC) arise from the injection of high-density substances used to modify the body in order to harmonize gender identity and/or gender expression and represent an emerging public health problem. Among transgender women, limited access to gender-affirming healthcare, together with other psychosocial, structural, and social factors, may contribute to the use of body modification practices intended to harmonize gender identity and gender expression, including the use of injectable materials. We conducted a retrospective analytical study among transgender women with a history of filler injections receiving care at three public referral centers in Mexico City between September 2024 and July 2025. Participants were identified through review of available clinical records and transgender care registries. Transgender identity was determined based on self-identified gender documented in the clinical record and confirmed through clinical chart review. Demographic, clinical, and social variables were collected to characterize FRC and associated factors. FRC were defined as documented inflammatory, infectious, migratory, or mixed manifestations temporally associated with prior filler exposure and attributed by the treating clinical team to filler injections. A total of 222 transgender women were included, with a median age of 45 years (IQR 38–52). Overall, 99 participants (44.5%) were classified as having FRC, most commonly inflammatory or mixed presentations. Materials referred to as “biopolymers” were the most frequently reported injected substances, followed by injectable oils, and among participants with available information, 93% of injections were performed by non-medical personnel. The time between filler injection and symptom onset exceeded 5 years in 54% of participants with FRC. More than one-third of affected participants required hospitalization attributable to FRC. Nearly half of transgender women with prior filler injections experienced complications, underscoring the substantial morbidity associated with filler injections performed outside supervised medical care. These findings highlight the multifactorial structural and social context surrounding non-medically supervised filler use, including barriers to gender-affirming healthcare, and the need for multidisciplinary care pathways for FRC. Because this retrospective study was conducted at referral centers, severe complications may be overrepresented.