Mortality Rates
A total of 317 (10.8%) transgender women and 44 (2.7%) transgender men died during the duration of the study, which equated to an overall mortality rate of 628 deaths per 100,000 people per year.
In comparison to men in the general Dutch population, the mortality risk was nearly double among transgender women and was nearly triple in comparison to cis women (ratios of 1.8 and 2.8, respectively).
An analysis of the subgroups show transgender women were 2.6 times as likely to die of cardiovascular disease, 3.1 times as likely to die from lung cancer, 8.7 times as likely to die from infection, and 6.1 times as likely to die from non-natural causes as cis women.
The greatest risk for those suffering from cardiovascular disease was heart attacks, which were 3 times higher in transgender women than cis women.
Most likely the starkest difference was the mortality risk from HIV, which was 47.6 times higher for transgender women in comparison to cis women.
Finally, the suicide rate was 6.8 times higher for transgender women.
While the differences were not as high for transgender men, they were still higher than cis women in comparison. Overall, the mortality rates between the 2 groups was similar, with transgender men 1.1 times as likely to die as cis men.
One difference, however, is transgender men who started hormone treatment between 1990-2000 was 2.6 times higher than cis women.
The mortality risk for transgender men was 2.1 times higher compared to cis women between 2000-2010 and 2.4 times higher between 2010-2018.
In addition, transgender men were 3.3 times more likely to die from non-natural causes than cis women.
The investigators also said more research is needed on this topic and there were some limitations due to the use of medical records that could have missing data or other discrepancies.
“Gender-affirming hormone treatment is thought to be safe, and most causes of death in the cohort were not related to this,” den Heijer said. “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.”