Oral Health for Transgender Individuals Seeking Gender-Affirming Care

March 29, 2024

Seattle's LGBTQ+ Center (formerly GayCity) and Delta Dental of Washington have teamed up to provide you with this resource. For more information about trans health resources and to support Seattle's LGBTQ+ Center, visit them here.


Gender Identity: Gender Identity designates a person’s concept of self as male, female, or a blend of both or neither (gender X or non-binary) and reflects how individuals perceive and call themselves.

Transgender: Identifying with a gender that differs from the sex one was assigned at birth. The latin origin of “Trans” means the opposite of.

Sex assigned at birth: The biological sex one is assigned at the time they are born. Generally, in western cultures this is done by a doctor or medical professional based on external sex characteristics.

Body dysphoria: Psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity

Gender affirming care: Ideal medical, surgical and mental health services sought by transgender, non-binary and gender non-conforming people. Gender-affirming medical care can range from routine preventive health care to hormone replacement, surgery or other interventions. Mental health services may include therapy, psychiatric medication and letter writing.

Why gender affirming care?

Due in part to social stigma and body dysphoria, the transgender population is at a higher risk of mental illness including depression, anxiety, and suicide. Among transgender adults, almost half report being verbally harassed in the past year. And 1 in 10 are physically attacked or sexually assaulted in a given year. But at least one study found that transgender youth who underwent some kind of gender-affirming care were 60% less likely to report feelings of depression.

In order to align their external gender expression with their gender identity, a person may decide to medically transition under the supervision and guidance of their physician. This can include receiving any number of gender affirming surgeries and/or hormone replacement therapy. Undergoing gender-affirming care can be a long and very personal process for transgender people. It can be uncomfortable, both physically and emotionally, and can also be prohibitively expensive. But in cases where a person and their doctor decide it is appropriate, gender-affirming care can also be both life-changing and life-saving.

Thanks to the ongoing efforts of transgender and nonbinary individuals sharing their experiences, our understanding of gender is continuously evolving. We know, for example, that a person’s biological sex does not necessarily always equate to a person’s desired expression of their gender identity. Furthermore, we understand that transgender is a broad term and can be used regardless of how the individual chooses to pursue their own personal gender expression.

Oral health implications of hormone therapy

Hormone therapy can have various effects on the body, including potential changes to oral health. Patients undergoing hormone therapy may experience dry mouth, which can increase their risk for tooth decay and gum disease. In addition, gender-affirming surgeries, such as facial feminization surgery, may change jaw alignment and bite impacting oral health. It's important to be aware of, and adjust treatment plans according to these potential outcomes for transgender patients.

Here are some of the most common oral health changes to be aware of during gender-affirming care:

  • A reduction in bone density which may lead to periodontal disease
  • Changes in immune response that lead to more prevalent bacteria associated with periodontal disease
  • Higher risk of jaw fractures due to a lower bone density
  • Dry mouth
  • Burning mouth syndrome
  • Changes to your jaw structure and bite alignment

Barriers to oral health in the transgender community

Negative associations with the medical system and social stigma against transgender people and how that can cause them to distrust or avoid treatment altogether In 2015, this report from the National Center for Transgender Equality found that 23 percent of transgender people who responded said that they did not seek needed medical care for fear of being mistreated.

But the barriers are present even when transgender individuals find a provider they trust. The journal, Dimensions of Dental Hygiene wrote that, “Multiple studies have shown that transgender people face barriers to health care caused by lack of adequate insurance coverage, bias from health care providers, and providers’ inexperience at treating transgender patients.”

What is the role of your dentist?

A patient undergoing gender-affirming care has embarked on an emotionally and physically demanding journey. Providers should take great care to create a trusting and positive environment so that their patients receive the best care available. Some examples of how they can do this include:

  1. Creating a welcoming and inclusive environment is essential for providing quality healthcare to all patients.
  2. Training staff on the appropriate language and protocols for working with patients; including using the appropriate pronouns, creating gender-neutral restrooms and communicating with patients' about their needs and concerns.