The use and correlates of illicit silicone or "fillers" in a population-based sample of transwomen, San Francisco, 2013.

INTRODUCTION: There is a dearth of studies to quantify the use of illicit fillers by transwomen. Case studies of illicit filler injections have pointed to an array of serious health complications, including death.

AIMS: The aims of this study were to determine the population prevalence and identify correlates of filler use among transwomen in San Francisco, CA.

METHODS: An analysis of data collected in 2013 with a population-based sample of 233 transwomen recruited using respondent-driven sampling (RDS). We used RDS weights to conduct bivariate and multivariate analyses of correlates of filler use.

MAIN OUTCOME MEASURES: Main outcome measures were an RDS-weighted population prevalence of filler use among transwomen and differences in demographic characteristics, transition-related care factors, and self-esteem related to appearance.

RESULTS: Weighted filler prevalence among transwomen was 16.7%. Being a transwoman between 30 and 49 years of age, owning/renting or living with a partner/family/friend, having had and planning to have surgery in the future, and having used nonprescribed hormones were all significantly associated with filler use. HIV was not associated with filler use.

CONCLUSIONS: This study provides the first known estimate to date of the prevalence of filler use in a population-based sample of transwomen in San Francisco. Accessing illicit fillers may be the only choice available for many transwomen to make changes to their appearance due to the high cost of legal surgeries and other cosmetic procedures. An important next step in this research is to determine the overall prevalence and long-term consequences of filler use among transwomen, to explore how the use of fillers is protective to the safety and well-being of transwomen, and to find safe and affordable alternatives to this method that meet important gender-related appearance needs.