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The Biosocial Microbiome: Gender Identity, Geography, and Mucosal Microbial Phenotypes.
Vanessa Van Doren1, S Smith1, Cassie Grimsley-Ackerley1
1The Hope Clinic of the Emory Vaccine Center.
Research Square
|February 6, 2026
Summary
Transgender women (TGW) and men who have sex with men (MSM) have distinct rectal microbiomes influenced by gender identity and geography. Feminizing hormone therapy did not significantly alter rectal microbiota in TGW.
Area of Science:
- Microbiome research
- HIV prevention science
- Transgender health
Background:
- Transgender women (TGW) face high HIV incidence and unique hormonal environments, yet their mucosal microbiome remains understudied.
- The influence of gender identity, feminizing hormone therapy (FHT), and geographic location on mucosal microbial composition in TGW is largely unknown.
- Understanding these factors is crucial for developing targeted HIV prevention strategies for key populations.
Purpose of the Study:
- To investigate the impact of gender identity, FHT, and geography on the rectal and neovaginal mucosal microbiome in TGW and cisgender men who have sex with men (MSM).
- To identify microbial differences associated with HIV risk factors in TGW.
- To explore potential shifts in rectal microbiota following FHT initiation.
Main Methods:
- Cross-sectional and longitudinal study involving TGW and MSM without HIV in Atlanta, USA, and Bangkok, Thailand.
- Collection of rectal and neovaginal mucosal swabs for 16S rRNA sequencing to analyze microbiota composition.
- Assessment of associations between microbial communities, gender identity, geography, and serum hormone levels using linear decomposition modeling and BOUTH analysis.
Main Results:
- Rectal microbiota composition significantly differed by both gender identity and geographic location.
- Transgender women showed enrichment of estrogen-metabolizing taxa, while MSM had Prevotellaceae enrichment in Atlanta.
- Neovaginal microbiota differed from rectal microbiota, with enrichment of taxa linked to HIV seroconversion; short-term FHT did not significantly alter rectal microbiota.
Conclusions:
- Gender identity is a significant factor shaping mucosal microbial phenotypes relevant to HIV vulnerability in TGW.
- Geographic location also plays a critical role in determining mucosal microbial composition.
- Mucosal microbiota may influence HIV risk in TGW, necessitating consideration of these factors in prevention efforts.
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