A study in the Netherlands found that they were twice as likely to die as their cisgender peers. However, the structure of causes of death has changed over the decades. This was shown by a study published in The Lancet Diabetes & endocrinology. Scientists point out that this data should be projected to other countries with caution.
Transgender people experience a mismatch between their biological sex and gender identity. They may go through various therapies to make their body better match the way they perceive themselves. One of them is hormonal therapy. Transgender men (who were born with female sex characteristics) 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 studies demonstrated abnormally high mortality among transgender people receiving hormone therapy. Whether this trend has reversed in recent years, however, 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, the authors collected information about these people: age at treatment, medical history, lifestyle data. These data covered 5-11 years.
The risk of death in 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 higher.
Transgender women had a higher risk of death than cisgender men:
- from cardiovascular diseases – 1.4 times,
- for lung cancer – almost 2 times,
- from infections – 5.4 times,
- from unnatural causes – 2.7 times,
- from suicide – 3.1 times,
- HIV-related causes by almost 15 times.
Compared to cisgender women, transgender women had a 2-fold risk of dying from cardiovascular disease , 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 in transgender men was almost the same as in cisgender men, but 1.6 times higher than in cisgender women. Transgender men died from unnatural causes 3.3 times more often than cisgender women.
The authors of the study noted that most of the most significant causes of death of transgender people are not related to hormonal 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 public attitudes and treatment could play an important role in reducing mortality from these causes. But it was surprising that the risk of death was higher in transgender people who started hormone therapy in the last two decades. This could be due to changes in clinical practice. In the past, doctors often denied such therapy to people with comorbidities, such as diseases of the cardiovascular system. Denials for these 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 a study, suffers less than the health of transgender women. Commenting on this, scientists point out that this may be due to the fact that transgender men use well-proven testosterone regimens in the treatment of hypogonadism. The differences may also be related to the different influence of hormones on cardiovascular risk.
Scientists indicate that they need to be careful when projecting their data to other countries.