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Objective <p>To evaluate facial volumetric changes in transgender (trans) individuals undergoing gender-affirming hormone therapy (GAHT) using stereophotogrammetry (Vectra H1).</p> Methods <p>This 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.</p> Results <p>Gender had a significant global multivariate effect on the combined set of facial volumes at all time points (<i>p</i> &lt; 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.</p> Conclusion <p>GAHT 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.</p>

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Three-dimensional facial volumetric changes in transgender individuals induced by gender-affirming hormone therapy: a stereophotogrammetric assessment

  • 期刊论文

  • 发表日期：

    2025年10月10日

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  • Alex Moreira Mélo,
  • Caio Sberni Pinheiro de Souza,
  • Melissa de Oliveira Melchior,
  • Manoel Damião de Sousa-Neto,
  • Fabiane Carneiro Lopes-Olhê,
  • Sérgio Henrique Pires Okano,
  • Lúcia Alves da Silva Lara,
  • Laís Valencise Magri,
  • Jardel Francisco Mazzi-Chaves

摘要

Objective

To evaluate facial volumetric changes in transgender (trans) individuals undergoing gender-affirming hormone therapy (GAHT) using stereophotogrammetry (Vectra H1).

Methods

This 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.

Results

Gender 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.

Conclusion

GAHT 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.