“The findings of our large, nationwide study highlight a substantially increased mortality risk among transgender people that has persisted for decades,” den Heijer said in a statement reported by HCPLive.
He added the observational data analysis suggests cross-sex hormone treatments may not be as safe in the long term as has been accepted:
Gender-affirming hormone treatment is thought to be safe, and most causes of death in the cohort were not related to this. However, as there is insufficient evidence at present to determine their long-term safety, more research is needed to fully establish whether they in any way affect mortality risk for transgender people.
UMC operates a gender identity clinic, and, as the authors explain, data of transgender individuals who received hormone treatments between 1972 and 2018 were linked to Statistics Netherlands.
The study included the data of 4,568 adult transgender individuals – 2927 transgender women (biological men) and 1641 transgender men (biological women). The mean age of the patient population at the start of hormone treatments was 30 years for transgender women and 23 years for transgender men.
The researchers compared the ratio of deaths among transgender individuals to the rates for the general population. In addition, they defined mortality subgroups for cardiovascular disease, lung cancer, HIV-related disease, and suicide.
In the follow-up, 317 (10.8 percent) transgender women (biological men) and 44 (2.7 percent) transgender men (biological women) died during the study.
Mortality risk among transgender women was found to be nearly twice as high as that of men without gender dysphoria (ratio of 1.8) and nearly three times as high as women without gender dysphoria (ratio of 2.8).
“Cause-specific mortality in transgender women was high for cardiovascular disease, lung cancer, HIV-related disease, and suicide,” the researchers wrote.
For transgender men (biological women), the data analysis found the mortality rate was 1.1 times that of men without gender dysphoria, revealing little difference.
Transgender boy Damian of New York takes part in the NYC Pride March as part of World Pride commemorating the 50th Anniversary of the Stonewall Uprising on June 30, 2019, in New York City. (Photo credit should read ANGELA WEISS/AFP via Getty Images)
However, transgender men were 3.3 times more likely to die as a result of “non-natural causes,” for example, suicide, than women without gender dysphoria.
The researchers wrote:
This observational study showed an increased mortality risk in transgender people using hormone treatment, regardless of treatment type. This increased mortality risk did not decrease over time. The cause-specific mortality risk because of lung cancer, cardiovascular disease, HIV-related disease, and suicide gives no indication to a specific effect of hormone treatment, but indicates that monitoring, optimising, and, if necessary, treating medical morbidities and lifestyle factors remain important in transgender health care.
“Increasing social acceptance, and monitoring and treatment for cardiovascular disease, tobacco use, and HIV, will continue to be important factors that may contribute to decreasing mortality risk in transgender people,” den Heijer said, according to HCPLive.