Transgender individuals who undergo hormone therapy see changes in their facial features within the first year of treatment, according to new research in the Journal of Sexual Medicine.

Facial changes may continue for at least a year, the authors noted, which may have implications for the timing of facial surgery.

Having a face that resembles their desired gender is often important for transgender patients. But until this study, experts were not sure to what extent hormone therapy contributed to this goal.

Researchers in the Netherlands worked with groups of transmen and transwomen who took hormones.

• After three months, results were available for 19 transwomen and 14 transmen. At the twelve-month follow-up point, data were available for 15 transwomen and 9 transmen.
• Using 3-dimensional imaging techniques, the researchers identified 22 soft tissue “landmarks” – focused facial areas that could indicate the degree of facial deviation. Images for each participant were taken at baseline, three months later, and twelve months later.
• The participants also completed questionnaires to assess their satisfaction with their facial appearance and self-esteem.
• After twelve months, transwomen’s cheek tissue increased, and jaw tissue decreased, approximating a more feminine face. Transmen’s cheek tissue was reduced, and the jaw became more prominent, for a more masculine look.
• Changes were already noticeable at the three-month mark, the researchers said.
• Both transwomen and transmen reported increased satisfaction with their appearance.
• However, they did not experience any changes in self-esteem, a finding that ran against previous research. The authors recommended further study in this area.

They did acknowledge some limitations. For example, the imaging techniques picked up very small facial movements, which might have included changes in facial expression rather than hormone-related changes in facial features. Also, there was no control group.

“The participants of this study perceive an imbalance between their actual face and the face of their experienced gender, but they might be satisfied with the symmetry or freshness of their face,” the authors added.

“A questionnaire that contains questions about the experienced or perceived femininity or masculinity of the face could provide more insight into the satisfaction with the face,” they wrote.

Overall, the findings could help transgender patients develop “more realistic expectations” about facial changes associated with hormonal therapy, the authors said. And because facial features continued to change after a year, it’s possible that facial surgery may be undertaken too early.

The authors suggested further research on the effects of race and ethnicity on facial features in transgender patients. Imaging techniques that address changes in facial tissues (as opposed to the current 3-D imaging that focuses on the facial surface) may also be considered.

Resources

• The Journal of Sexual Medicine - “Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures”
  Tebbens, Marieke, et al.
  (Full-text. Published online: March 26, 2019)
  https://www.jsm.jsexmed.org/article/S1743-6095(19)30413-8/fulltext