Pyogenic granuloma in a transgender woman: Possible association to the hormonal therapy




Transsexualism; Estradiol; Cyproterone acetate; Pyogenic granuloma.


Transgender persons can be understood as those whose gender identity does not conform to the norms imposed by society regarding the gender designated at birth, based on the genitalia. Obviously, secondary sex characteristics are contingent on sex steroids. Hormonal reassignment has two aims: to reduce the hormonally induced secondary sex characteristics of the original sex and to induce the secondary sex characteristics of the new sex. The use of these sex steroid hormones can favor the development of oral mucosal lesions, such as pyogenic granuloma, which it is a non-neoplastic vascularized lesion, common in the oral cavity, caused by trauma, local irritants, or hormonal factors. The etiology is currently unclear, but trauma and increased level of estrogen and progesterone have been suggested as potential contributing factors. Therefore, the main purpose of this article is to report a pyogenic granuloma developing in a male-to-female transsexual patient which may be associated to the hormonal therapy and highlights the effects of hormone therapy on oral tissues


Adeyemo, W. L., Hassan, O. O., & Ajayi, O. F. (2011). Pregnancy-associated pyogenic granuloma of the lip: a case report. Niger J Med 2011, 20(1), 179-180.

Agha-Hosseini, F. H., Tirgari, F., & Shaigan, S. (2006). Immunohistochemical analysis of estrogen and progesterone receptor expression in gingival lesions. Iran J Public Health, 35(2), 38-41.

Al-Khateeb, T., & Ababneh, K. Oral pyogenic granuloma in Jordanians: a retrospective analysis of 108 cases. (2003). J Oral Maxillofac Surg, 61(11), 1285-1288. 10.1016 / s0278-2391 (03) 00729-8.

Amaral, A. F. R., Silva, D. G., Cordeiro, D. M., Assunção, L. F. O., Alves, N. R., Oliveira, T. C, et al. (2017). Side effects arising from hormonal therapy in girls transexuals. Brazilizan Journal of Surgery and Clinical Research, 20(3), 103-110.

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders. APA.

Asscheman, H., Gooren, L. J., & Eklund, P. L. (1989). Mortality and morbidity in transsexual patients with cross-gender hormone treatment. Metabolism, 38(9), 869-873. 10.1016 / 0026-0495 (89) 90233-3.

Buchner, A., Shnaiderman-Shapiro, A., & Vered, M. (2010). Relative frequency of localized reactive hyperplastic lesions of the gingiva: a retrospective study of 1675 cases from Israel. J Oral Pathol Med, 39(8), 631-638. 10.1111 / j.1600-0714.2010.00895.x.

Esmeili, T., Lozada-Nur, F., & Epstein, J. (2005). Common benign oral soft tissue masses. Dent Clin North Am, 49(1), 223-240. doi:10.1016/j.cden.2004.07.001.

Figueiredo, C. S. A., Rosalem, C. G. C., Cantanhede, A. L. D., Thomaz, E. B. A. F., & Cruz, M. C. F. N. (2017). Systemic alterations and their oral manifestations in pregnant women. J Obstet Gynaecol Res, 43(1), 16-22. 10.1111/jog.13150.

Fox, P. C., Busch, K. A., & Baum, B. J. (1987). Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc, 115(4), 581-584. 10.1016 / s0002-8177 (87) 54012-0.

Gomez-Gil, E., Canizares, S., Torres, A., Torre, F., Halperin, I., & Salamero, M. (2009). Androgen treatment effects on memory in female-to-male transsexuals. Psychoneuroendocrinology, 34(1), 110-117. 10.1016 / j.psyneuen.2008.08.017.

Goodman, M. P. (2012). Are all estrogens created equal? A review of oral vs. transdermal therapy. J Womens Health, 21(2), 161-169. 10.1089 / jwh.2011.2839.

Hembree, W. C., Cohen-Kettenis, P., Delemarre-van de Waal, H. A., Gooren, L. J., Meyer, W. J., Spack, N. P, et al. (2009). Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 94(9), 3132-3154. 10.1210/jc.2009-0345.

Jafarzadeh, H., Sanatkhani, M., & Mohtasham, N. (2006). Oral pyogenic granuloma: a review. J Oral Sci, 48(4), 167-175. 10.2334 / josnusd.48.167.

Krejci, C. B., & Bissada, N. F. (2002). Women's health issues and their relationship to periodontitis. J Am Dent Assoc, 133(3), 323–329. 10.14219 / jada.archive.2002.0171.

Kruger, A., Sperandei, S., Bermudez, X. P. C. D., & Merchán-Hamann, E. (2019). Characteristics of hormone use by travestis and transgender women of the Brazilian Federal District. Rev bras epidemiol, 22 (1).

Leary, M. R., & Kowalski, R. M. (1995). Emotions and social behavior. Social Anxiety. Guilford Press,.

Manegold-Brauer, G., & Brauer, H. U. (2014). Oral pregnancy tumour: an update. J Obstet Gynaecol, 34(2), 187-188. 10.3109 / 01443615.2013.834308.

Mealey, B. L., & Moritz, A. J. (2003). Hormonal influences: effects of diabetes mellitus and endogenous female sex steroid hormones on the periodontium. Periodontol 2000, 32(1), 59-81.

Michel, A., Mormont, C., & Legros, J. J. (2001). A psycho-endocrinological overview of transsexualism. Eur J Endocrinol, 145(4), 365-376. doi:10.1530/eje.0.1450365.

Neville, B. W., & Day, T. A. (2002). Oral cancer and precancerous lesions. CA: a Cancer Journal for Clinicians, 52(4), 195-215. 10.3322 / canjclin.52.4.195.

Pereira, A. S., Shitsuka, D. M, Parreira, F. J. & Shitsuka, R. (2018). Metodologia da pesquisa científica. UFSM. /1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica. pdf.

Regezi, J. A., Sciubba, J. J., & Jordan, R. C. K. (2003). Oral pathology: clinical pathologic considerations. Philadelphia: WB Saunders.

Tangpricha, V., & Heijer, M. (2017). Oestrogen and anti-androgen therapy for transgender women. Lancet Diabetes Endocrinol, 5(4), 291-300. 10.1016 / S2213-8587.

Tsai, K. Y., Wang, W. H., Chang, G. H., & Tsai, Y. H. (2015). Treatment of pregnancy-associated oral pyogenic granuloma with life-threatening haemorrhage by transarterial embolization. J of Laryngology & Otology, 129(6), 607-610. 10.1017 / S0022215115001176.

Unger, C. A. Hormone therapy for transgender patients. (2016). Transl Androl Urol, 5(6), 877-884. 10.21037 / tau.2016.09.04.

Vilmann, A., Vilmann, P., & Vilmann, H. (1986). Pyogenic granuloma: evaluation of oral condition. Britsh Journal of Oral and Maxillofacial Surgery, 24(5), 376-382. 10.1016/ 0266-4356 (86) 90023-9.

Wang, P. H., Chao, H. T., Lee, W. L., Yuan, C. C., & Ng, H. T. (1997). Severe bleeding from a pregnancy tumor: A case report. J Reprod Med, 42(6), 359-362.

Werinard, J. D., & Safer, J. D. (2015). Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals. J Clin Transl Endocrinol, 2(2), 55-60. 10.1016/j.jcte.2015.02.003.24.

Wierckx, K., Elaut, E., Declercq, E., Heylens, G., Cuypere, G., Taes, Y., Kaufman, J. M, et al. (2013). Prevalence of cardiovascular disease and cancer during cross-sex HRT in a large cohort of trans persons: a case-control study. Eur J Endocrinol, 169(4), 471-478. 10.1530 / EJE-13-0493.

Yih, W. Y., Richardson, L., Kratochvil, F. J., Avera, S. P., & Zieper, M. B. (2000). Expression of estrogen receptors in desquamative gingivitis. J Periodontol, 71(3), 482-487. 10.1902 / jop.2000.71.3.482.



How to Cite

OLIVEIRA , L. E. de; LIMA, C. B. B. e; ITO, F. A.; LIMA, H. G. de; TAKAHAMA JUNIOR , A. . Pyogenic granuloma in a transgender woman: Possible association to the hormonal therapy. Research, Society and Development, [S. l.], v. 10, n. 6, p. e52810615408, 2021. DOI: 10.33448/rsd-v10i6.15408. Disponível em: Acesso em: 20 jun. 2021.



Health Sciences