MORTALITY AND MORBIDITY IN TRANSSEXUAL SUBJECTS TREATED WITH CROSS-SEX HORMONES

OBJECTIVE The optimum steroid hormone treatment regimes for transsexua l subjects has not yet been established. We have investigated the mort ality and morbidity figures in a large group of transsexual subjects r eceiving cross-sex hormone treatment. DESIGN A retrospective, descript ive study in a university teaching hospital. SUBJECTS Eight hundred an d sixteen male-to-female (M --> F) and 293 female-to-male (F --> M) tr anssexuals. INTERVENTIONS Subjects had been treated with cross-sex hor mones for a total of 10 152 patient-years. OUTCOME MEASURES Standardiz ed mortality and incidence ratios were calculated from the general Dut ch population (age-and gender-adjusted) and were also compared to side effects of cross-sex hormones in transsexuals reported in the literat ure. RESULTS In both the M --> F and F --> M transsexuals, total morta lity was not higher than in the general population and, largely, the o bserved mortality could not be related to hormone treatment, Venous th romboembolism was the major complication in M --> F transsexuals treat ed with oral oestrogens and anti-androgens, but fewer cases were obser ved since the introduction of transdermal oestradiol in the treatment of transsexuals over 40 years of age, No cases of breast carcinoma but one case of prostatic carcinoma were encountered in our population, N o serious morbidity was observed which could be related to androgen tr eatment in the F --> M transsexuals. CONCLUSION Mortality in male-to-f emale and female-to-male transsexuals is not increased during cross-se x hormone treatment, Transdermal oestradiol administration is recommen ded in male-to-female transsexuals, particularly in the population ove r 40 years in whom a high incidence of venous thromboembolism was obse rved with oral oestrogens. It seems that in view of the deep psycholog ical needs of transsexuals to undergo sex reassignment, our treatment schedule of cross-sex hormone administration is acceptably safe.