Transgender people are twice as likely to die compared to cisgender men and women, according to an analysis of national data from the Netherlands.
The analysis of data, published in The Lancet on 3 September, involved more than 4500 transgender people and spanned five decades.
It indicated that the heightened mortality risk among transgender people did not decrease between 1972 and 2018.
Therefore authors described a “pressing need for action” to address these long-standing and significant health disparities.
Lead author Martin den Heijer, professor at Amsterdam UMC in the Netherlands, said that the study findings highlight a substantially increased mortality risk among transgender people “that has persisted for decades”.
Transgender people can undergo medical therapies that bring about physical changes that more closely match their gender identity. These typically include gender-affirming hormone therapy and surgery.
Transgender men receiving gender-affirming hormone therapy are usually treated with testosterone to promote the development of masculine features, while transgender women typically receive antiandrogens and oestrogens, which induce feminine physical characteristics.
The data has shown that the mortality risk was almost double among transgender women compared to men in the general Dutch population, and nearly three times greater compared to cis women. Mortality risk in transgender men was similar to cis men but almost double compared to cis women.
On observed disparities between transgender women and transgender men, Vin Tangpricha of Emory University in the United States, who was not involved in the study, said that transgender men do not appear to have significantly increased comorbidity following receipt of gender-affirming hormone therapy when compared with transgender women.
“These results could reflect the use of an established regimen of testosterone administration extrapolated from hypogonadal men. The differences could also reflect disparities in the access of health care, differences in the effect of sex hormones on cardiometabolic risk profile, differences in body composition, or societal factors,” he said.
Tangpricha added that “future studies should examine which factors—hormone regimen, hormone concentrations, access to health care, or other biological factors—explain the increased risk of morbidity and mortality observed in transgender women as opposed to transgender men.”
Researchers hope that 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.
First author Christel de Blok, of Amsterdam UMC, said: “We found that most suicides and deaths related to HIV occurred in the first decades we studied, suggesting that greater social acceptance and access to support, and improved treatments for HIV, may have played an important role in reducing deaths related to these causes among transgender people in recent years”.
She added that it was surprising that mortality risk was higher in transgender people who started gender-affirming hormone treatment in the past two decades, “but this may be due to changes in clinical practice”.
“In the past, health care providers were reluctant to provide hormone treatment to people with a history of comorbidities such as cardiovascular disease. However, because of the many benefits of enabling people to access hormone therapy, nowadays this rarely results in the treatment being denied,” she explained.
Heijer also highlighted the need for future studies.
“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,” he concluded.
[Edited by Benjamin Fox]