Transgender Identity Dimensions and Unmet Dental Care Needs Among Korean Transgender Adults

BACKGROUND: Transgender individuals experience oral health disparities, yet the contribution of transgender identity-related psychosocial experiences to unmet dental care remains poorly understood in Asian populations. This study examined associations between four dimensions of the Transgender Identity Survey (TIS) - Pride, Passing, Alienation, and Shame (each scored on a 1-7 scale) - and unmet dental care among Korean transgender adults, using Andersen's Behavioral Model. METHODS: Cross-sectional data were analysed from 333 Korean transgender adults recruited through community-based sampling. The primary outcome was self-reported unmet dental care since first disclosing or recognizing gender identity. The validated 26-item TIS assessed four identity dimensions. Hierarchical logistic regression adjusted for predisposing, enabling, and need factors, with all subscales entered simultaneously. Stratified analyses examined hormone therapy status and gender identity. RESULTS: Unmet dental care was reported by 211 participants (63.4%). In the fully adjusted model, Pride (aOR 1.79, 1.28-2.49), Passing (aOR 1.50, 1.19-1.88), and Shame (aOR 1.56, 1.12-2.17) were associated with unmet dental care. Sensitivity analyses identified classical suppression between Pride and Shame (r = -0.80), with only Passing robustly associated across specifications. Gender-affirming hormone therapy was strongly protective (aOR 0.26, 0.15-0.45). CONCLUSIONS: Passing emerged as the most robust psychosocial predictor of unmet dental care among Korean transgender adults, with Pride and Shame exhibiting classical suppression in joint models. Gender-affirming hormone therapy was a strong enabling factor. These findings suggest that trans-affirming dental care should address interpersonal competency and anticipated identity exposure barriers, tailored by transition stage and gender identity.