Trans people twice as likely to die as cis men, women: Lancet study over 5 decades

Transgender people are twice as likely to die compared to cisgender men and women, according to an analysis of country-wide data from the Netherlands spanning five decades.  This mortality risk among transgender people did not decrease between 1972 and 2018.  

Mortality risk was higher in trangender women compared to transgender men, the study, published in journal Lancet Diabetes and Endocrinology September 2, 2021, noted.

Another major point of observation was the gender-affirming hormone treatment — that trans people opt for to induce desired physical changes and that has side effects — may have led to an increase in mortality. The side effects of such a therapy include cardiovascular disease and cancer.

The findings, according to the lead author of the study Martin den Heijer, point to a need for acceptance, and monitoring and treatment for cardiovascular disease, tobacco use and human immunodeficiency virus (HIV) infection among transgender people.

Experts flagged the publication of data on the safety of gender-affirming hormone therapy in the transgender population “encouraging”. Heijer told Down to Earth: “The results of the study could be projected on other countries as well, although disparities in helathcare for transgenders in other countries may be even greater because of social stigma.”

What does the study say

Transgender people experience incongruence between their sex assigned at birth and their gender identity. It was estimated in 2015 that one out of every 2,800 ‘birth-assigned males’ and 1 out of every 5,200 ‘birth-assigned females’ received medical treatment for gender dysphoria in the Netherlands.

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.

Over the past years, a substantial increase has been observed in the number of referrals for transgender healthcare — for psychological, endocrine or surgical treatment.

While, according to the paper, hormone therapy is considered safe, not much data is available on the same, leading to insufficient evidence to determine long-term effects of the therapy.

The study surveyed of 4,568 adult transgender people — 2,927 transgender women and 1,641 transgender men — who had attended the gender identity clinic at Amsterdam UMC between 1972 and 2018. All of them received or were receiving gender-affirming hormone treatment during the said period.

The median age at the start of hormone treatment was 30 years in transgender women and 23 years in transgender men. The median follow-up time in transgender women was 11 years and 5 years in transgender men.

During follow-up, 317 (10.8 per cent) transgender women and 44 (2.7 per cent) transgender men died, resulting in an overall mortality of 628 deaths per 100,000 people per year.

Most of the deaths from HIV-related disease in this study, however, occurred in the first decades studied, indicating an effect of improved HIV treatment over recent years.

Among other findings of the study were:

• Mortality risk was almost double among transgender women compared to trans men in the general Dutch population, and nearly three times greater compared to cis women. This mortality risk did not decrease over the five decades.
• Transgender women had 1.4 times greater risk of death compared to cis men because of cardiovascular disease. Mortality risk was almost double for lung cancer, more than five times greater for infection, and nearly three times as high for non-natural causes of death.
• The greatest mortality risk from infection was associated with HIV-related disease, at nearly 15 times higher than for cis men.
• Compared with cis women, transgender women were more than two times as likely to die of cardiovascular disease. They were three times more likely to die from lung cancer.

For non-natural causes of death, the greatest risk was suicide, at three times greater than for cis men. The study, however, noted that most suicide cases occurred in the first decades studied.

This may have been due to increased awareness among health-care providers regarding suicide risk in transgender people. An increase in social acceptance may have contributed to the decreased number of suicides over the past years, the study noted.

Heinjer told DTE: “The conclusion of our paper is that the increased risk of mortality is not explained by the hormone treatment itself. The increased risk for cardiovascular disease, lung cancer, infections (including HIV) and non-natural causes of death (including suicide) may be explained by lifestyle factors and mental and social wellbeing.”

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