Impact of gender-affirming hormone therapy on dry eye

Purpose To determine whether gender-affirming hormone therapy (GAHT) influences tear system health in transgender individuals. Methods This retrospective cohort observational study analyzed data from transgender men and women ages ≥18-years between 2004 and 2024 via electronic medical record (EMR) data. Following propensity score matching, subjects on hormone therapy included 23,623 transgender men, 15,933 transgender women, and an equal number in each matched control group. Results Among transgender men and women, respectively, tear system disorders occurred in 0.90% and 0.94% of those using GAHT and 0.90% and 1.17% of those not using GAHT ( p = 0.211 and 0.072). There was no significant difference in those with documented utilization of GAHT versus no GAHT, for both transgender men and women, respectively, in lacrimal system disorder ( p = 0.427, p = 0.292), meibomian gland dysfunction ( p = 0.687, p = 0.255), keratoconjunctivitis sicca ( p = 0.685, p = 0.576), and combined tear disorders ( p = 0.527, p = 0.168). Conclusions In this cohort, EMR-documented masculinizing or feminizing GAHT was not associated with an increased incidence of recorded tear-system disorders.