Background: Gender-affirming hormone treatment in transgender people potentially has side effects, such as cardiovascular disease and cancer, with a potential increase in mortality. We aimed to investigate trends in mortality over time in a large cohort of transgender people.
Methods: Data of transgender people who received hormone treatment were linked to Statistics Netherlands. Per transgender person, five birth year-matched control males and females were randomly drawn from the Dutch population and included in the analyses.
Results: 2,387 trans women (male sex assigned at birth, female gender identity) and 1,366 trans men (female sex assigned at birth, male gender identity) were included. In trans women, mortality risk decreased slowly over time resulting in no increased risk in recent years. In trans men, no overall increased mortality risk was observed over time. In the years with an observed higher mortality in trans women, this increased risk was explained by a higher mortality due to HIV-related disease (OR 15.9, 95%CI 3.5-73.3 compared to cis men and 25.7, 3.3-201.6 compared to cis women), suicide (OR 2.3, 95%CI 1.3-3.9 compared to cis men and 2.3, 1.3-4.1 compared to cis women), and unknown causes compared to cis men (OR 2.2, 95%CI 1.2-4.0). Most HIV-related deaths and suicide cases occurred before 2008. In trans men, periods of increased mortality in time were explained by an increased risk due to unknown causes of death (OR 15.0, 95%CI 1.6-138.8).
Interestingly, no increased mortality was observed due to cardiovascular disease or cancer.
Conclusion: In recent years mortality risk was not increased in transgender people. The observed increased risk before 2008 was not related to hormone treatment-related diseases, but to HIV and suicide. These findings strengthen the thought that hormone treatment in transgender healthcare is safe.