Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures

Marieke Tebbens, Nienke M. Nota, Niels P.T.J. Liberton, Brigitte A. Meijer, Baudewijntje P.C. Kreukels, Tim Forouzanfar, Rudolf M. Verdaasdonk, Martin den Heijer

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction: Hormone treatment induces feminization of the body in transwomen and masculinization in transmen. However, the effect of hormone treatment on facial characteristics is still unknown. Aim: We aimed to study whether hormone treatment induces facial feminization and masculinization and how this potential change affects satisfaction and self-esteem. Methods: In this single-center cohort study, we included 27 transwomen and 15 transmen who received standardized hormone treatment in the Center of Expertise on Gender Dysphoria, VU University Medical Center Amsterdam. Facial 3-dimensional images were obtained at baseline and at 3 and 12 months. At each image, 22 facial landmarks were placed. Furthermore, the FACE-Q Satisfaction with Facial Appearance Overall and the Rosenberg self-esteem scale were obtained at the same measurement points. Main Outcome Measures: The main outcome measures included the relative local shift of skin in millimeters in the 22 landmarks in the transverse (x-axis), coronal (y-axis), and sagittal (z-axis) anatomic axes, the color maps, and the outcomes of the questionnaires. Results: After 12 months, cheek tissue in transwomen increased, with 0.50 mm (95% CI 0.04–0.96) in the x-axis and 1.08 mm (95% CI 0.31–1.85) in the z-axis. Tissue in the jaws decreased with −0.60 mm (95% CI −1.28–0.08) in the x-axis and −0.18 mm (95% CI −0.03–0.33) in the y-axis. Cheek tissue in transmen decreased with −0.45 mm (95% CI −1.00–0.11) in the x-axis and −0.84 mm (95% CI −1.92–0.25) in the z-axis. These changes already started after 3 months. An increase in satisfaction with the facial appearance was found in both transwomen and transmen. There were no changes in reported self-esteem. Clinical implication: These results could lead to more realistic expectations of facial changes. Furthermore, our results suggest that the face continues to change for at least a year, which could suggest that performing facial feminization surgery after 1 year of hormone treatment might be too early. Strength & Limitations: This study is the first that provides insight into the facial changes in transgender individuals receiving hormone treatment, and it introduces an objective method to examine (small) facial changes. Our study is limited by the poor reliability of the landmarks, the difficulty of facial fixation, and the lack of gender-specific questions in the questionnaires. Conclusions: Hormone treatment in transwomen induces an increase in cheek tissue and a decrease in jaw tissue. In transmen a tendency of decrease in cheek tissue and an increase in jaw tissue was found. These changes are in the direction of the desired gender. Tebbens M, Nota NM, Liberton NPTJ, et al. Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures. J Sex Med 2019;16:746–754.

Original languageEnglish
Pages (from-to)746-754
Number of pages9
JournalJournal of sexual medicine
Volume16
Issue number5
Early online date26 Mar 2019
DOIs
Publication statusPublished - May 2019

Fingerprint

Feminization
Hormones
Cheek
Jaw
Self Concept
Outcome Assessment (Health Care)
Transgender Persons
Patient Reported Outcome Measures
Therapeutics
Cohort Studies
Color
Skin

Keywords

  • 3D Scanning
  • Facial Characteristics
  • Feminization
  • Hormone Treatment
  • Masculinization
  • Transgender

Cite this

Tebbens, Marieke ; Nota, Nienke M. ; Liberton, Niels P.T.J. ; Meijer, Brigitte A. ; Kreukels, Baudewijntje P.C. ; Forouzanfar, Tim ; Verdaasdonk, Rudolf M. ; den Heijer, Martin. / Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen : Quantification by 3D Scanning and Patient-Reported Outcome Measures. In: Journal of sexual medicine. 2019 ; Vol. 16, No. 5. pp. 746-754.
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title = "Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures",
abstract = "Introduction: Hormone treatment induces feminization of the body in transwomen and masculinization in transmen. However, the effect of hormone treatment on facial characteristics is still unknown. Aim: We aimed to study whether hormone treatment induces facial feminization and masculinization and how this potential change affects satisfaction and self-esteem. Methods: In this single-center cohort study, we included 27 transwomen and 15 transmen who received standardized hormone treatment in the Center of Expertise on Gender Dysphoria, VU University Medical Center Amsterdam. Facial 3-dimensional images were obtained at baseline and at 3 and 12 months. At each image, 22 facial landmarks were placed. Furthermore, the FACE-Q Satisfaction with Facial Appearance Overall and the Rosenberg self-esteem scale were obtained at the same measurement points. Main Outcome Measures: The main outcome measures included the relative local shift of skin in millimeters in the 22 landmarks in the transverse (x-axis), coronal (y-axis), and sagittal (z-axis) anatomic axes, the color maps, and the outcomes of the questionnaires. Results: After 12 months, cheek tissue in transwomen increased, with 0.50 mm (95{\%} CI 0.04–0.96) in the x-axis and 1.08 mm (95{\%} CI 0.31–1.85) in the z-axis. Tissue in the jaws decreased with −0.60 mm (95{\%} CI −1.28–0.08) in the x-axis and −0.18 mm (95{\%} CI −0.03–0.33) in the y-axis. Cheek tissue in transmen decreased with −0.45 mm (95{\%} CI −1.00–0.11) in the x-axis and −0.84 mm (95{\%} CI −1.92–0.25) in the z-axis. These changes already started after 3 months. An increase in satisfaction with the facial appearance was found in both transwomen and transmen. There were no changes in reported self-esteem. Clinical implication: These results could lead to more realistic expectations of facial changes. Furthermore, our results suggest that the face continues to change for at least a year, which could suggest that performing facial feminization surgery after 1 year of hormone treatment might be too early. Strength & Limitations: This study is the first that provides insight into the facial changes in transgender individuals receiving hormone treatment, and it introduces an objective method to examine (small) facial changes. Our study is limited by the poor reliability of the landmarks, the difficulty of facial fixation, and the lack of gender-specific questions in the questionnaires. Conclusions: Hormone treatment in transwomen induces an increase in cheek tissue and a decrease in jaw tissue. In transmen a tendency of decrease in cheek tissue and an increase in jaw tissue was found. These changes are in the direction of the desired gender. Tebbens M, Nota NM, Liberton NPTJ, et al. Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures. J Sex Med 2019;16:746–754.",
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Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen : Quantification by 3D Scanning and Patient-Reported Outcome Measures. / Tebbens, Marieke; Nota, Nienke M.; Liberton, Niels P.T.J.; Meijer, Brigitte A.; Kreukels, Baudewijntje P.C.; Forouzanfar, Tim; Verdaasdonk, Rudolf M.; den Heijer, Martin.

In: Journal of sexual medicine, Vol. 16, No. 5, 05.2019, p. 746-754.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen

T2 - Quantification by 3D Scanning and Patient-Reported Outcome Measures

AU - Tebbens, Marieke

AU - Nota, Nienke M.

AU - Liberton, Niels P.T.J.

AU - Meijer, Brigitte A.

AU - Kreukels, Baudewijntje P.C.

AU - Forouzanfar, Tim

AU - Verdaasdonk, Rudolf M.

AU - den Heijer, Martin

PY - 2019/5

Y1 - 2019/5

N2 - Introduction: Hormone treatment induces feminization of the body in transwomen and masculinization in transmen. However, the effect of hormone treatment on facial characteristics is still unknown. Aim: We aimed to study whether hormone treatment induces facial feminization and masculinization and how this potential change affects satisfaction and self-esteem. Methods: In this single-center cohort study, we included 27 transwomen and 15 transmen who received standardized hormone treatment in the Center of Expertise on Gender Dysphoria, VU University Medical Center Amsterdam. Facial 3-dimensional images were obtained at baseline and at 3 and 12 months. At each image, 22 facial landmarks were placed. Furthermore, the FACE-Q Satisfaction with Facial Appearance Overall and the Rosenberg self-esteem scale were obtained at the same measurement points. Main Outcome Measures: The main outcome measures included the relative local shift of skin in millimeters in the 22 landmarks in the transverse (x-axis), coronal (y-axis), and sagittal (z-axis) anatomic axes, the color maps, and the outcomes of the questionnaires. Results: After 12 months, cheek tissue in transwomen increased, with 0.50 mm (95% CI 0.04–0.96) in the x-axis and 1.08 mm (95% CI 0.31–1.85) in the z-axis. Tissue in the jaws decreased with −0.60 mm (95% CI −1.28–0.08) in the x-axis and −0.18 mm (95% CI −0.03–0.33) in the y-axis. Cheek tissue in transmen decreased with −0.45 mm (95% CI −1.00–0.11) in the x-axis and −0.84 mm (95% CI −1.92–0.25) in the z-axis. These changes already started after 3 months. An increase in satisfaction with the facial appearance was found in both transwomen and transmen. There were no changes in reported self-esteem. Clinical implication: These results could lead to more realistic expectations of facial changes. Furthermore, our results suggest that the face continues to change for at least a year, which could suggest that performing facial feminization surgery after 1 year of hormone treatment might be too early. Strength & Limitations: This study is the first that provides insight into the facial changes in transgender individuals receiving hormone treatment, and it introduces an objective method to examine (small) facial changes. Our study is limited by the poor reliability of the landmarks, the difficulty of facial fixation, and the lack of gender-specific questions in the questionnaires. Conclusions: Hormone treatment in transwomen induces an increase in cheek tissue and a decrease in jaw tissue. In transmen a tendency of decrease in cheek tissue and an increase in jaw tissue was found. These changes are in the direction of the desired gender. Tebbens M, Nota NM, Liberton NPTJ, et al. Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures. J Sex Med 2019;16:746–754.

AB - Introduction: Hormone treatment induces feminization of the body in transwomen and masculinization in transmen. However, the effect of hormone treatment on facial characteristics is still unknown. Aim: We aimed to study whether hormone treatment induces facial feminization and masculinization and how this potential change affects satisfaction and self-esteem. Methods: In this single-center cohort study, we included 27 transwomen and 15 transmen who received standardized hormone treatment in the Center of Expertise on Gender Dysphoria, VU University Medical Center Amsterdam. Facial 3-dimensional images were obtained at baseline and at 3 and 12 months. At each image, 22 facial landmarks were placed. Furthermore, the FACE-Q Satisfaction with Facial Appearance Overall and the Rosenberg self-esteem scale were obtained at the same measurement points. Main Outcome Measures: The main outcome measures included the relative local shift of skin in millimeters in the 22 landmarks in the transverse (x-axis), coronal (y-axis), and sagittal (z-axis) anatomic axes, the color maps, and the outcomes of the questionnaires. Results: After 12 months, cheek tissue in transwomen increased, with 0.50 mm (95% CI 0.04–0.96) in the x-axis and 1.08 mm (95% CI 0.31–1.85) in the z-axis. Tissue in the jaws decreased with −0.60 mm (95% CI −1.28–0.08) in the x-axis and −0.18 mm (95% CI −0.03–0.33) in the y-axis. Cheek tissue in transmen decreased with −0.45 mm (95% CI −1.00–0.11) in the x-axis and −0.84 mm (95% CI −1.92–0.25) in the z-axis. These changes already started after 3 months. An increase in satisfaction with the facial appearance was found in both transwomen and transmen. There were no changes in reported self-esteem. Clinical implication: These results could lead to more realistic expectations of facial changes. Furthermore, our results suggest that the face continues to change for at least a year, which could suggest that performing facial feminization surgery after 1 year of hormone treatment might be too early. Strength & Limitations: This study is the first that provides insight into the facial changes in transgender individuals receiving hormone treatment, and it introduces an objective method to examine (small) facial changes. Our study is limited by the poor reliability of the landmarks, the difficulty of facial fixation, and the lack of gender-specific questions in the questionnaires. Conclusions: Hormone treatment in transwomen induces an increase in cheek tissue and a decrease in jaw tissue. In transmen a tendency of decrease in cheek tissue and an increase in jaw tissue was found. These changes are in the direction of the desired gender. Tebbens M, Nota NM, Liberton NPTJ, et al. Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures. J Sex Med 2019;16:746–754.

KW - 3D Scanning

KW - Facial Characteristics

KW - Feminization

KW - Hormone Treatment

KW - Masculinization

KW - Transgender

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DO - 10.1016/j.jsxm.2019.02.011

M3 - Article

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JO - Journal of sexual medicine

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