A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones

Abstract

Objective: Adverse effects of long-term cross-sex hormone administration to transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones. Design: A cohort study with a median follow-up of 18.5 years at a university gender clinic. Methods: Mortality data and the standardized mortality rate were compared with the general population in 966 male-to-female (MtF) and 365 female-to-male (FtM) transsexuals, who started cross-sex hormones before July 1, 1997. Follow-up was at least 1 year. MtF transsexuals received treatment with different high-dose estrogen regimens and cyproterone acetate 100 mg/day. FtM transsexuals received parenteral/oral testosterone esters or testosterone gel. After surgical sex reassignment, hormonal treatment was continued with lower doses. Results: In the MtF group, total mortality was 51% higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome, cardiovascular disease, drug abuse, and unknown cause. No increase was observed in total cancer mortality, but lung and hematological cancer mortality rates were elevated. Current, but not past ethinyl estradiol use was associated with an independent threefold increased risk of cardiovascular death. In FtM transsexuals, total mortality and cause-specific mortality were not significantly different from those of the general population. Conclusions: The increased mortality in hormone-treated MtF transsexuals was mainly due to nonhormone-related causes, but ethinyl estradiol may increase the risk of cardiovascular death. In the FtM transsexuals, use of testosterone in doses used for hypogonadal men seemed safe.

Informed Consent in the Medical Care of Transgender and Gender-Nonconforming Patients

“…Within the context of a pervasive and continued cultural discomfort with gender variant identities, it is perhaps understandable that clinicians might focus on and even overestimate the potential for harm of gender-affirming treatments and the possibility that some patients might experience future regret. Historically, scientific data on which to base treatment guidelines and discussions of risks and benefits has been sparse, but the accumulated experience of clinicians treating transgender patients and the results of the growing number of studies that have become available suggest that hormone therapy and surgery are relatively safe and have the potential to improve the psychological state and psychosocial functioning of transgender patients [13][14][15].…”

Management von Jugendlichen mit Transidentität

“…Die Autoren beobachteten selbst eine höhere Rate von Studienteilnehmern mit höherer Bildung im Vergleich zur holländischen Allgemeinbevölkerung (58 % vs. 31 %), was zur niedrigeren psychiatrischen Begleitsymptomatik beigetragen haben könnte [8]. [29]. Psychologische Follow-up-Studien an hormonbehandelten Erwachsenen zeigten -wobei nicht ganz einheitlich und signifikantnurbeiMzF -eine verbesserte Lebensqualität (Übersicht in [30]).…”

The primary health care of transgender adults

“…Deaths from hormone treatments and gender surgery, however, are rare. [11][12][13][14] Endocrine therapies for transgender people are generally safe and effective, 2,3,8,12 and complications from endocrine therapies are not significant contributors to mortality in observational and cohort studies. 11,14 This implies that delivering specialised endocrine and surgical interventions alone is insufficient to reduce health disparity, and primary health care is likely to be an important contributor for effecting meaningful improvements in the health of transgender populations.…”

“…15 Mortality among transgender populations is significantly higher than the general population. 11,14 Among those who have undergone sex reassignment surgery, mortality continues to exceed that of the general population. 11,14 Suicide, HIV/AIDS, liver failure and cardiovascular disease contribute heavily to the excess mortality, suggesting that mental health and risk-taking behaviour are important issues to address.…”

“…11,14 Suicide, HIV/AIDS, liver failure and cardiovascular disease contribute heavily to the excess mortality, suggesting that mental health and risk-taking behaviour are important issues to address. 11,14 The following introduces some selected topics in transgender health that have interest and relevance to primary care.…”