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

SPS commentary:

According to commentary, one major limitation of the study is that children who initiated therapy on gonadotropin-releasing hormone agonists and were later followed-up as adults were excluded. Other limitations were that information on serum concentrations of sex steroid hormones was not available for the cohort and thus some of the risks reported could be due to supraphysiological dosing of sex steroid hormones in some of the transgender women who developed cardiovascular mortality. Despite these limitations, it considers this study an important well-established cohort to study the long-term morbidity and mortality of transgender women. It notes the European Network for the Investigation of Gender Incongruence has reported unfavourable changes in lipid profiles in transgender women and the Study of Transition, Outcomes and Gender has reported increased risk of venous thromboembolism and ischaemic stroke in transgender women followed for up to 10 years. In the future, the Trans Youth Care study will report on health outcomes in youth who received gender-affirming hormone therapies close to the time of puberty. It adds that these newer cohorts have not yet reported mortality in their cohort members but as these cohorts mature, data will become available to help guide clinicians in the prescription of gender-affirming hormone therapy.