Cross-sex hormone therapy related adverse events: data from a large gender identity unit

Introduction: Hormonal therapy is part of an established treatment of gender identity disorder, however outcome data regarding mortality and morbidity are scant.

Methods: A specialist center cross-sectional study in 193 transsexual women and 128 transsexual men (mean age 42.5 years) assessing physical health and incidence of possible treatment related adverse events compared to an age-matched female and male control group recruited from a population study in Flanders (1–3 matching). Participants on average used 7.4 years of cross-sex hormone therapy (range: 3 months–49 years) and were 6.6 years since sex reassignment surgery (SRS).

Results: Ten transsexual persons (one transsexual men and nine transsexual women) died during follow-up. Causes of death were suicide, cardiovascular disease (n=2), cancer (n=2) and suicide (n=6). Three percentage of transsexual women (n=10) experienced venous thrombosis and/or pulmonary embolism during hormonal therapy. Half of them occurred during the first treatment year (n=5), another three at time of SRS. Transsexual women experienced more myocardial infarction (MI) compared to control women (P=0.001) but not to control men. Prevalence of cerebrovascular disease (CVD) was higher in transsexual women compared to control men and women (P=0.05 and P=0.02; respectively). Transsexual men had similar morbidity rates of MI and CVD compared to control population.

Prevalence of type 2 diabetes was higher in both transsexual men and women compared to control women. However, all but one diagnosis in transsexual women were found before start of hormonal therapy suggesting overdiagnosis. We observed an equal prevalence of cancers and HIV infection in transsexual persons compared to control population.

Conclusion: Data of the current study indicate a higher mortality rate in transsexual women and more venous thrombosis, MI and CVD. Transsexual men had similar morbidity rates compared to the general population, apart from a higher incidence of type 2 diabetes.

Source: www.endocrine-abstracts.org