Transgender people perceive a mismatch between their biological sex and gender identity. They may undergo a variety of therapies to help their bodies better match the way they perceive themselves. One of them is hormonal treatment. Transgender men (who were born with the sex characteristics of women) receive testosterone, and transgender women receive antiandrogens and estrogens. This treatment is considered safe in the short term. But little is known about its long-term effects.
Early research showed abnormally high mortality rates among transgender people receiving hormone therapy. However, whether this trend has changed in recent years was unknown. In the new study, researchers analyzed data on 2,927 transgender men and 1,641 transgender women who received hormone therapy in Amsterdam from 1972 to 2018. From medical records, its authors collected information about these people: age at treatment, medical history, and lifestyle data. These data covered 5-11 years.
The risk of death among transgender women compared to cisgender men (those who are satisfied with their biological sex) was 1.8 times higher, and compared to cisgender women – 2.8 times.
Transgender women had a higher risk of death than cisgender men:
- from cardiovascular diseases – 1.4 times,
- from lung cancer – almost 2 times,
- from infections – 5.4 times,
- from unnatural reasons – 2.7 times,
- from suicide – 3.1 times,
- reasons associated with HIV infection – almost 15 times.
Compared to cisgender women, the risk of death from cardiovascular diseases in transgender women was 2.6 times higher, from lung cancer – 1.3 times, from infections – 8.7 times, from unnatural causes – 6 times. from HIV infection – almost 50 times.
The risk of death for transgender men was almost the same as for cisgender men, but 1.6 times higher than for cisgender women. Transgender men died from unnatural causes 3.3 times more often than cisgender women.
The study authors noted that most of the most significant causes of death in transgender people are not related to hormone therapy.
“We found that the majority of HIV-related suicides and deaths occurred in the first decade covered by the study. This suggests that improved social attitudes and treatment could play an important role in reducing deaths from these causes. But it was unexpected that the risk of death was higher in transgender people who started hormone therapy in the past two decades. This could be due to changes in clinical practice. Previously, doctors often refused such therapy to people with concomitant diseases, such as diseases of the cardiovascular system. Failures for such reasons are now rare, ”said Christel de Blok of the University Medical Centers Amsterdam, co-author of the study.
The health of transgender men, according to the study, suffers less than the health of transgender women. Commenting on this, the scientists point out that this may be due to the fact that testosterone regimens are used for transgender men well-proven in the treatment of hypogonadism. Also, the differences may be due to the different effects of hormones on cardiovascular risk.
Scientists point out that caution should be exercised when projecting their findings to other countries.