Mortality and morbidity in transsexual subjects treated with cross‐sex hormones

Abstract

Mortality in male-to-female and female-to-male transsexuals is not increased during cross-sex hormone treatment. Transdermal oestradiol administration is recommended in male-to-female transsexuals, particularly in the population over 40 years in whom a high incidence of venous thromboembolism was observed with oral oestrogens. It seems that in view of the deep psychological needs of transsexuals to undergo sex reassignment, our treatment schedule of cross-sex hormone administration is acceptably safe.

Cardiovascular disease in transsexual persons treated with cross-sex hormones: reversal of the traditional sex difference in cardiovascular disease pattern

“…In other studies of FtoM transsexual persons, a lower or similar cardiovascular morbidity was observed compared with a control population (15,16,56), although one study (17) found a higher cardiovascular mortality rate in FtoM whereas another, in a larger population with a longer term follow-up, did not confirm this (14). Most of the evidence suggests that testosterone treatment in FtoM is relatively safe at short and medium follow-up, although it should be noted that outcome studies in transsexual men are carried out in smaller sample sizes and at significantly younger age of FtoM compared with MtoF.…”

“…In two reports on health status (15,16), analyzing also cardiovascular disease in the transsexual population in the gender clinic in Amsterdam, we were unable to establish an increase in cardiovascular pathology. However, in a report on mortality in the same transsexual subjects published in 2011 (14), we found that ischemic heart disease was the cause of death in 18 MtoF subjects, among the 966 MtoF followed during a mean of 19.4 years of cross-sex hormone treatment.…”

“…Two studies, assessing mortality in transsexual persons, indeed observed an increased cardiovascular mortality in MtoF compared with the general population (14,17). Interestingly, the Kaplan-Meier curve diverged after about 10 years of follow-up, which could explain previous research that observed no higher cardiovascular mortality after on average 9 years of follow-up (15). The observation of increased cardiovascular morbidity and mortality during cross-sex hormone therapy in MtoF subjects is not entirely unexpected in as far as a parallel can be drawn with hormone use in women.…”

“…The current evidence largely suggests that administration of cross-sex hormone therapy to MtoF (15,16) is associated with increased cardiovascular risk. Two studies, assessing mortality in transsexual persons, indeed observed an increased cardiovascular mortality in MtoF compared with the general population (14,17).…”

Acute effects of 17β-estradiol on femoral veins from adult gonadally intact and ovariectomized female pigs

“…endothelium; hyperpolarizing factor; nitric oxide; potassium channels OBSERVATIONAL AND EPIDEMIOLOGICAL studies suggest that oral hormone replacement therapy provides primary prevention of coronary artery disease in postmenopausal women while it also increases the risk of venous thrombosis (5,20,23,40,49,54,55). The reasons for these apparent opposite effects on the arterial and venous systems are not known.…”