Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria.

Published on Oct 1, 2021in The Lancet Diabetes & Endocrinology32.069
· DOI :10.1016/S2213-8587(21)00185-6
Christel Jm de Blok2
Estimated H-index: 2
(UvA: University of Amsterdam),
Chantal M. Wiepjes3
Estimated H-index: 3
(UvA: University of Amsterdam)
+ 5 AuthorsMartin den Heijer6
Estimated H-index: 6
(UvA: University of Amsterdam)
Sources
Abstract
Summary null null Background null Increased mortality in transgender people has been described in earlier studies. Whether this increased mortality is still present over the past decades is unknown. Therefore, we aimed to investigate trends in mortality over five decades in a large cohort of adult transgender people in addition to cause-specific mortality. null null null Methods null We did a retrospective cohort study of adult transgender people who visited the gender identity clinic of Amsterdam University Medical Centre in the Netherlands. Data of transgender people who received hormone treatment between 1972 and 2018 were linked to Statistics Netherlands. People were excluded if they used alternating testosterone and oestradiol treatment, if they started treatment younger than age 17 years, or if they had ever used puberty-blockers before gender-affirming hormone treatment. Standardised mortality ratios (SMRs) were calculated using general population mortality rates stratified by age, calendar period, and sex. Cause-specific mortality was also calculated. null null null Findings null Between 1972 and 2018, 8831 people visited the gender identity clinic. 4263 were excluded from the study for a variety of reasons, and 2927 transgender women and 1641 transgender men were included in the study, with a total follow-up time of 40 232 person-years for transgender women and 17 285 person-years for transgender men. During follow-up, 317 (10·8%) transgender women died, which was higher than expected compared with general population men (SMR 1·8, 95% CI 1·6–2·0) and general population women (SMR 2·8, 2·5–3·1). Cause-specific mortality in transgender women was high for cardiovascular disease, lung cancer, HIV-related disease, and suicide. In transgender men, 44 people (2·7%) died, which was higher than expected compared with general population women (SMR 1·8, 95% CI 1·3–2·4) but not general population men (SMR 1·2, 95% CI 0·9–1·6). Cause-specific death in transgender men was high for non-natural causes of death. No decreasing trend in mortality risk was observed over the five decades studied. null null null Interpretation null This observational study showed an increased mortality risk in transgender people using hormone treatment, regardless of treatment type. This increased mortality risk did not decrease over time. The cause-specific mortality risk because of lung cancer, cardiovascular disease, HIV-related disease, and suicide gives no indication to a specific effect of hormone treatment, but indicates that monitoring, optimising, and, if necessary, treating medical morbidities and lifestyle factors remain important in transgender health care. null null null Funding null None.
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Although Veterans Affairs (VA) directives and initiatives have sought to ensure an affirmative environment for transgender and gender diverse (TGD) veterans, barriers to care persist, including enacted/anticipated stigma as well as providers' lack of knowledge regarding specific health concerns of the TGD community. These barriers are significant in light of prior research, which has demonstrated a relationship between fears of transphobic discrimination and avoiding or delaying health care enga...
Source
#1Chantal M. Wiepjes (VUmc: VU University Medical Center)H-Index: 10
#2M. den Heijer (VUmc: VU University Medical Center)H-Index: 16
Last. Thomas D. Steensma (VUmc: VU University Medical Center)H-Index: 26
view all 7 authors...
OBJECTIVE: This study explored the overall suicide death rate, the incidence over time, and the stage in transition where suicide deaths were observed in transgender people. METHODS: A chart study, including all 8263 referrals to our clinic since 1972. Information on death occurrence, time, and cause of death was obtained from multiple sources. RESULTS: Out of 5107 trans women (median age at first visit 28 years, median follow-up time 10 years) and 3156 trans men (median age at first visit 20 ye...
Source
#1Christel J.M. de Blok (VUmc: VU University Medical Center)H-Index: 9
#2Koen M.A. Dreijerink (VUmc: VU University Medical Center)H-Index: 22
Last. Martin den Heijer (VUmc: VU University Medical Center)H-Index: 76
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Gender-affirming hormonal treatment (HT) in transgender people is considered safe in general, but the question regarding (long-term) risk on sex hormone-related cancer remains. Because the risk on certain types of cancer differs between men and women, and some of these differences are attributed to exposure to sex hormones, the cancer risk may be altered in transgender people receiving HT. Although reliable epidemiologic data are sparse, the available data will be discussed in this article. Furt...
Source
#1Michael Goodman (Emory University)H-Index: 59
#2Noah AdamsH-Index: 7
Last. Eli Coleman (UMN: University of Minnesota)H-Index: 54
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Accurate estimates of the number and proportion of transgender and gender nonconforming people in a population are necessary for developing data-based policy and for planning and funding of health care delivery and research. The wide range of estimates reported in the literature is attributable primarily to differences in definitions. Other sources of variability include diverse cultural and geographic settings and important secular trends. The transgender and gender nonconforming population is ...
Source
#1Daan M van Velzen (UvA: University of Amsterdam)H-Index: 4
#2Alessia Paldino (UniTS: University of Trieste)H-Index: 1
Last. Martin den Heijer (UvA: University of Amsterdam)H-Index: 6
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CONTEXT: The impact of gender-affirming hormone therapy (HT) on cardiometabolic parameters is largely unknown. OBJECTIVE: The effects of 1 year of treatment with oral or transdermal administration of estrogen (plus cyproterone) and transdermal or IM application of testosterone on serum lipid levels and blood pressure (BP) were assessed in transgender persons. DESIGN AND METHODS: In this prospective, observational substudy of the European Network for the Investigation of Gender Incongruence, meas...
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#1Christel J.M. de Blok (VU: VU University Amsterdam)H-Index: 9
#2Chantal M. WiepjesH-Index: 10
Last. Martin den Heijer (VU: VU University Amsterdam)H-Index: 76
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Abstract Objective To investigate the incidence and characteristics of breast cancer in transgender people in the Netherlands compared with the general Dutch population. Design Retrospective, nationwide cohort study. Setting Specialised tertiary gender clinic in Amsterdam, the Netherlands. Participants 2260 adult trans women (male sex assigned at birth, female gender identity) and 1229 adult trans men (female sex assigned at birth, male gender identity) who received gender affirming hormone trea...
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#1Nienke M Nota (VU: VU University Amsterdam)H-Index: 3
#2Chantal M Wiepjes (VU: VU University Amsterdam)H-Index: 6
Last. Martin den Heijer (VU: VU University Amsterdam)H-Index: 76
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In hypogonadal/postmenopausal individuals, hormone therapy has been associated with an increased risk for cardiovascular events (CVEs). A steeply growing population that often receives exogenous hormones are transgender individuals. While transgender individuals hypothetically have an increased risk of CVEs, there is little known about the occurrence of CVEs in this population(1). Therefore, we determined the incidences of acute/spontaneous strokes (ischemic/haemorrhagic, transient ischemic atta...
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#1Darios Getahun (KP: Kaiser Permanente)H-Index: 23
#2Rebecca Nash (Emory University)H-Index: 10
Last. Michael Goodman (Emory University)H-Index: 59
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Background: Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use. Objective: To examine the incidence of these events in a cohort of transgender persons. Design: Electronic medical record-based cohort study of transgender members of integrated health care systems who had an index date (first evidence of transgender status) from 2006 through 2014. Ten male and 10 female cisgender enrollees were matched to each transgender pa...
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#1Nienke M Nota (VU: VU University Amsterdam)H-Index: 3
#2Chantal M Wiepjes (VU: VU University Amsterdam)H-Index: 6
Last. Martin den Heijer (VU: VU University Amsterdam)H-Index: 76
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© The Author(s) (2018). Benign brain tumours may be hormone sensitive. To induce physical characteristics of the desired gender, transgender individuals often receive cross-sex hormone treatment, sometimes in higher doses than hypogonadal individuals. To date, long-term (side) effects of cross-sex hormone treatment are largely unknown. In the present retrospective chart study we aimed to compare the incidence of common benign brain tumours: meningiomas, pituitary adenomas (non-secretive and secr...
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Abstract Background Over the past decade, the number of people referred to gender identity clinics has rapidly increased. This raises several questions, especially concerning the frequency of performing gender-affirming treatments with irreversible effects and regret from such interventions. Aim To study the current prevalence of gender dysphoria, how frequently gender-affirming treatments are performed, and the number of people experiencing regret of this treatment. Methods The medical files of...
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