This randomized study evaluated whether patient gender identity influences dentists' clinical decision-making. Dentists in southern Brazil were randomly assigned to receive one of two versions of the same hypothetical dental clinical case. The cases were identical except for the patient's gender identity, which was presented as either a transgender woman or a cisgender woman.

Participants selected treatment options for anterior and posterior teeth and completed questionnaires regarding professional characteristics and knowledge about transgender health. The primary objective was to determine whether patient gender identity influenced treatment recommendations. Differences in clinical decision-making between groups were analyzed using regression models.

Clinical decision-making in dentistry may be influenced by factors beyond clinical findings, including professional characteristics, personal beliefs, and social perceptions. While disparities related to race and socioeconomic status have been documented in oral health care, little is known about the influence of patient gender identity on dentists' treatment decisions.

This randomized parallel-group study was conducted among practicing dentists in southern Brazil between September 2023 and April 2024. Participants were randomly assigned to evaluate one of two versions of a hypothetical dental clinical case. The clinical information, photographs, complaints, and treatment scenarios were identical in both versions, differing only in the patient's gender identity. In one version, the patient was identified as a transgender woman, while in the other the patient was identified as a cisgender woman.

Participants selected treatment options for an anterior tooth and a posterior tooth and subsequently completed questionnaires addressing sociodemographic characteristics, professional profile, previous experience with transgender patients, and training related to transgender health. The primary outcome was the treatment recommendation provided by the dentist. Recommendations were categorized into conservative and invasive treatment approaches for analysis.

The study aimed to determine whether patient gender identity influences dentists' clinical decision-making and to identify professional characteristics associated with treatment recommendations.

Inclusion Criteria:

• Professionally active dentists.
• Able and willing to provide informed consent.
• Practicing dentistry during the data collection period.

Exclusion Criteria:

• Dentists not actively practicing during the data collection period.
• Dentists who participated in the pilot study.
• Individuals who declined participation or did not provide informed consent.

Individual participant data will not be made publicly available because the study collected information from individual professionals under conditions of confidentiality and anonymity. Data sharing may be restricted by ethical and institutional requirements.

Participants were blinded to the primary objective of the study and were unaware that patient gender identity was the variable of interest. The informed consent form was modified to avoid revealing the specific focus of the research. In addition, the statistician responsible for data analysis remained blinded to group allocation throughout the analytical process.