de Blok Christel Jm, Wiepjes Chantal M, van Velzen Daan M, Staphorsius Annemieke S, Nota Nienke M, Gooren Louis Jg, Kreukels Baudewijntje Pc, den Heijer Martin
Department of Internal Medicine, Division of Endocrinology, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands.
Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands; Department of Medical Psychology, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands.
Lancet Diabetes Endocrinol. 2021 Oct;9(10):663-670. doi: 10.1016/S2213-8587(21)00185-6. Epub 2021 Sep 2.
Increased mortality in transgender people has been described in earlier studies. Whether this increased mortality is still present over the past decades is unknown. Therefore, we aimed to investigate trends in mortality over five decades in a large cohort of adult transgender people in addition to cause-specific mortality.
We did a retrospective cohort study of adult transgender people who visited the gender identity clinic of Amsterdam University Medical Centre in the Netherlands. Data of transgender people who received hormone treatment between 1972 and 2018 were linked to Statistics Netherlands. People were excluded if they used alternating testosterone and oestradiol treatment, if they started treatment younger than age 17 years, or if they had ever used puberty-blockers before gender-affirming hormone treatment. Standardised mortality ratios (SMRs) were calculated using general population mortality rates stratified by age, calendar period, and sex. Cause-specific mortality was also calculated.
Between 1972 and 2018, 8831 people visited the gender identity clinic. 4263 were excluded from the study for a variety of reasons, and 2927 transgender women and 1641 transgender men were included in the study, with a total follow-up time of 40 232 person-years for transgender women and 17 285 person-years for transgender men. During follow-up, 317 (10·8%) transgender women died, which was higher than expected compared with general population men (SMR 1·8, 95% CI 1·6-2·0) and general population women (SMR 2·8, 2·5-3·1). Cause-specific mortality in transgender women was high for cardiovascular disease, lung cancer, HIV-related disease, and suicide. In transgender men, 44 people (2·7%) died, which was higher than expected compared with general population women (SMR 1·8, 95% CI 1·3-2·4) but not general population men (SMR 1·2, 95% CI 0·9-1·6). Cause-specific death in transgender men was high for non-natural causes of death. No decreasing trend in mortality risk was observed over the five decades studied.
This observational study showed an increased mortality risk in transgender people using hormone treatment, regardless of treatment type. This increased mortality risk did not decrease over time. The cause-specific mortality risk because of lung cancer, cardiovascular disease, HIV-related disease, and suicide gives no indication to a specific effect of hormone treatment, but indicates that monitoring, optimising, and, if necessary, treating medical morbidities and lifestyle factors remain important in transgender health care.
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早期研究曾描述过跨性别者死亡率升高的情况。在过去几十年中，这种死亡率升高的情况是否仍然存在尚不清楚。因此，我们旨在调查一大群成年跨性别者在五十年间的死亡率趋势以及特定病因死亡率。
我们对前往荷兰阿姆斯特丹大学医学中心性别认同诊所就诊的成年跨性别者进行了一项回顾性队列研究。1972年至2018年间接受激素治疗的跨性别者的数据与荷兰统计局的数据相关联。如果他们使用交替的睾酮和雌二醇治疗、开始治疗时年龄小于17岁或在性别确认激素治疗前曾使用过青春期阻滞剂，则被排除在外。使用按年龄、日历时期和性别分层的一般人群死亡率计算标准化死亡率（SMR）。还计算了特定病因死亡率。
1972年至2018年间，8831人前往性别认同诊所就诊。4263人因各种原因被排除在研究之外，2927名跨性别女性和1641名跨性别男性被纳入研究，跨性别女性的总随访时间为40232人年，跨性别男性为17285人年。在随访期间，317名（10.8%）跨性别女性死亡，与一般人群男性相比高于预期（SMR 1.8，95%CI 1.6 - 2.0），与一般人群女性相比也高于预期（SMR 2.8，2.5 - 3.1）。跨性别女性中，心血管疾病、肺癌、HIV相关疾病和自杀的特定病因死亡率较高。在跨性别男性中，44人（2.7%）死亡，与一般人群女性相比高于预期（SMR 1.8，95%CI 1.3 - 2.4），但与一般人群男性相比不高于预期（SMR 1.2，95%CI 0.9 - 1.6）。跨性别男性中非自然原因导致的特定病因死亡较高。在所研究的五十年中未观察到死亡风险的下降趋势。
这项观察性研究表明，使用激素治疗的跨性别者死亡风险增加，无论治疗类型如何。这种增加的死亡风险并未随时间下降。肺癌、心血管疾病、HIV相关疾病和自杀导致的特定病因死亡风险并未表明激素治疗有特定影响，但表明在跨性别医疗保健中，监测、优化以及必要时治疗医学疾病和生活方式因素仍然很重要。
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