Mortality and morbidity in transsexual subjects treated with cross-sex
hormones.

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[from Medline]

AUTHOR:  van Kesteren PJ; Asscheman H; Megens JA; Gooren LJ
ADDRESS:  Department of Andrology, Free University Hospital,
Amsterdam, The Netherlands.
TITLE:  Mortality and morbidity in transsexual subjects
treated with cross-sex hormones.
SOURCE:  Clin Endocrinol (Oxf) (DCI), 1997 Sep; 47 (3):
337-42
LANGUAGE:  English
COUNTRY PUB.:  ENGLAND
PUB. TYPE:  JOURNAL ARTICLE

ABSTRACT:
OBJECTIVE: The optimum steroid hormone treatment regimes for transsexual
subjects has not yet been established. We have investigated the mortality
and morbidity figures in a large group of transsexual subjects receiving
cross-sex hormone treatment.

DESIGN: A retrospective, descriptive study in a university teaching
hospital.

SUBJECTS: Eight hundred and sixteen male-to-female (M-->F) and 293
female-to-male (F-- >M) transsexuals.

INTERVENTIONS: Subjects had been treated with cross-sex hormones for a
total of 10,152 patient-years.

OUTCOME MEASURES: Standardized mortality and incidence ratios were
calculated from the general Dutch population (age- and gender-adjusted) and
were also compared to side effects of cross-sex hormones in transsexuals
reported in the literature.

RESULTS: In both the M-->F and F-->M transsexuals, total mortality was not
higher than in the general population and, largely, the observed mortality
could not be related to hormone treatment. Venous thromboembolism was the
major complication in M-->F transsexuals treated with oral oestrogens and
anti- androgens, but fewer cases were observed 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. No serious morbidity was observed which
could be related to androgen treatment in the F-->M transsexuals.

CONCLUSION: Mortality in male-to- female and female-to-male transsexuals is
not increased during cross-sex hormone treatment. Transdermal oestradiol
administration is recommended in male-to-female transsexuals, particularly
in the population over 40 years in whom a high incidence of venous
thromboembolism was observed with oral oestrogens. It seems that in view of
the deep psychological needs of transsexuals to undergo sex reassignment,
our treatment schedule of cross-sex hormone administration is acceptably
safe.




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