Study reveals transgender people still face increased risk of death

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In a study spanning fifty years, researchers reveal that transgender people still face a disproportionate likelihood of death – an outcome not connected to gender-affirming hormone treatment

The research, published in The Lancet Diabetes & Endocrinology, finds that heightened risks of death among transgender people have not changed over the last fifty years. Between 1972 and 2018, health disparities between transgender and cis populations have remained largely intact in the Netherlands.

More awareness and new resistance

Now, gender-affirming hormone treatment is quietly considered to be dangerous or subversive, described by some as a ‘trend’. The much-lauded author J.K. Rowling infamously stood against transgender people in 2020, when she revealed that she was afraid of being attacked in a bathroom by transgender women. Citing birth sex, Ms Rowling wrote an essay to articulate why she stood against recognising transgender people as a protected class. A wave of online anti-trans sentiment arose, bleeding out into society.

In a section of her book The Transgender Issue, activist Shon Faye highlights a startling parallel – the treatment of gay people in the imminent past, and the treatment of transgender people today. She writes: “Just as, back in the 80s, the British media feared a “gay agenda” in schools, so in the late 2010s a similar panic was created about the idea of “gender ideology” infiltrating the education system.”

Contrary to public opinion, experts in healthcare assert that gender-affirming is a way to prevent transgender death.

Dr Vin Tangpricha of Emory University, USA, who was not involved in the study, said: “Increased publication of data on the safety of gender-affirming hormone therapy in the transgender population, which is lifesaving for many people, is encouraging.

“Continued refinement of delivery of care for transgender people will help to improve the lives of a clinically vulnerable growing population.”

Access to unbiased medical care still difficult

According to an unconnected review of transgender healthcare access across 17 countries, it is still difficult to get unbiased medical care.

In some cases, people assigned female at birth were afraid of being physically harmed due to a lack of knowledge from their doctors. They experienced pain during speculum examinations, if their physician was unaware of the effects of testosterone therapy on vaginal atrophy and “refused to use a really small speculum.”

In other cases, transgender youth from the Global South reported that they were unable to access a source of credible information, to know more about their bodies and healthcare needs – meaning that they were left vulnerable to specific mortality risks.

New data reveals transgender women twice as likely to die

Now, a study conducted over 50 years finds that death is twice as likely for transgender people as cisgender people – meaning that things may have changed a little, but they haven’t changed a lot.

The research involved 4,568 transgender people in the Netherlands, with 90% white people. The authors did not receive any funding for this work.

The situation for transgender women

According to the data, mortality risk was almost double for transgender women compared to cisgender men, then an incredible three times greater than cis women. This means that transgender women are more likely to die, but why?

Transgender women faced an increased risk of cardiovascular disease, lung cancer, infection, and non-natural causes of death. In the realm of infection, HIV-related deaths were 15 times higher in transgender women than cis men.

For non-natural death in transgender women, the biggest risk was suicide – at three times greater than for cis men.

The situation for transgender men

While the picture for transgender women was stark in contrast to cis men, it is slightly less so for transgender men. However, in contrast to cis women, transgender men still face a nearly-doubled likelihood of death.

In contrast to cis women, the risk of death was more than double in 2000 to 2010, then again in 2010 to 2018. Transgender men were also more than three times as likely to die from non-natural causes, namely, suicide and murder. While gender-affirming hormone treatment is known to be largely safe, risk of death in those who started hormone treatment between 1990 and 2000 was two and a half times higher as in cis women.

Transgender risk of death “has persisted for decades”

Lead author Professor Martin den Heijer, of Amsterdam UMC, the Netherlands, said: “The findings of our large, nationwide study highlight a substantially increased mortality risk among transgender people that has persisted for decades. Increasing social acceptance, and monitoring and treatment for cardiovascular disease, tobacco use, and HIV, will continue to be important factors that may contribute to decreasing mortality risk in transgender people.

“Gender-affirming hormone treatment is thought to be safe, and most causes of death in the cohort were not related to this.”

First author Christel de Blok, of Amsterdam UMC, the Netherlands, further commented: “It was surprising that mortality risk was higher in transgender people who started gender-affirming hormone treatment in the past two decades, but this may be due to changes in clinical practice. In the past, health care providers were reluctant to provide hormone treatment to people with a history of comorbidities such as cardiovascular disease.

“However, because of the many benefits of enabling people to access hormone therapy, nowadays this rarely results in treatment being denied.”

Read the full study here.


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