title: The use and correlates of illicit silicone or "fillers" in a population-based sample of transwomen, San Francisco, 2013.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: San Francisco Department of Public Health, Center for Public Health Research, San Francisco, CA, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Wilson
authors.forename: Jenna
authors.initials: J
authors.lastname: Rapues
authors.forename: Harry
authors.initials: H
authors.lastname: Jin
authors.forename: Henry Fisher
authors.initials: HF
authors.lastname: Raymond
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019736:Prostheses and Implants / Q000009:adverse effects / Q000706:statistics & numerical data*; D012107:Research Design; D012495:San Francisco / Q000453:epidemiology; D012747:Sexual Partners; D012828:Silicones; D063106:Transgender Persons / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D012828:Silicones
keywords: Complications; Gender Change Procedure; Silicone; Transgender Persons; Transwomen