Long term mortality in hormone-treated transsexuals

Long term mortality in hormone-treated transsexuals

2012-02-01 00:00:00

This study assessed mortality in a cohort of 1330 transsexuals: 965 male-to-female (MtF), mean age at start 31.4 years, 13,935 patient-years and 365 female-to-male (FtM), mean age at start 26.1 years, 5,550 patient-years. All patients who had started hormones before July 1, 1997 were included and followed till death, last visit or July 1, 2007. Causes of death (ICD-10) were ascertained by medical reports or general practioners.

Observed deaths were compared to the expected numbers (adjusted for age, original sex and period of follow up on hormone treatment) in the general population by standardized mortality ratio (SMR). In the MtF group total mortality was increased by 46% compared to the general population, due to increased numbers of suicide (6), drugs-related deaths (3) and AIDS (9) in the age group 25-39 and to suicide (8) and circulatory disease (13) in the group 40- 64 years old. The increased mortality rate of ischemic heart diseases (SMR:1.74) suggests rather an increased risk than a protective effect of estrogen therapy on IHD. Also the risk of fatal stroke was increased (SMR:2.04) No increased mortality was found in FtM.
In summary, androgen treatment of FtM appears reasonably safe but estrogen treatment of MtF appears associated with elevated IHD and stroke. Further analysis of the role of dose/type of estrogen (ethinylestradiol?) and smoking is needed. In MtF there is a high rate of suicide, AIDS and drugs-related mortality warranting intense preventive action and close follow up.
 

Conference: WAS Goteberg 2009
Areas of Interest / Categories: Androgen Therapy, Menopause, WAS 2009
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