Estudo da flora vaginal em homens transgênero em uso de testosterona

Abstract

Transgender men who retain female genital structures may have specific gynecological care needs, especially when using testosterone hormone therapy. Prolonged exposure to high levels of testosterone and estrogen suppression promotes changes in the vaginal epithelium and local microbiota, potentially favoring dysbiosis, such as bacterial vaginosis (BV). Despite this, there is still a scarcity of studies evaluating these changes in this group of patients. The objective of this study was to analyze the changes in the vaginal microbiota and the prevalence of bacterial vaginosis in transgender men using testosterone hormone therapy, through microbiological analysis of vaginal smear slides and the Nugent score, correlating the findings with clinical characteristics and hormone use. This is an observational, cross-sectional study conducted with 11 transgender men attending a specialized outpatient clinic. Vaginal secretion samples were collected for Gram staining analysis, with microbiota classification according to the Nugent score, in addition to the application of a clinical questionnaire on the characteristics of vaginal discharge. The average age of the participants was 29 ± 4.59 years, with 73% currently using testosterone. Lactobacillus was absent in 82% of the samples, and numerous Gram-variable bacilli were present in 36% of cases. The average Nugent score was 5.82 ± 2.86, indicating a predominance of intermediate microbiota, with cases compatible with bacterial vaginosis. Only 27% of participants reported vaginal discharge with clinical alterations. No significant association was observed between testosterone use and microbiological or clinical findings. However, the presence of Gram-variable bacilli showed a significant association with higher Nugent scores, compatible with bacterial vaginosis. It is concluded that transgender men using testosterone present relevant alterations in the vaginal microbiota, characterized by a reduction in Lactobacillus and a greater presence of microorganisms associated with bacterial vaginosis. These findings reinforce the need for specific attention to the health of this population, as well as the performance of studies with larger samples for a better understanding of the clinical implications of these alterations.