Summary
Australian researchers used national prescription, healthcare and death records to find about 29,000 people they classed as trans because they had filled a cross-sex hormone prescription: testosterone for people recorded as female, oestrogen for people recorded as male. They compared deaths with about 20 million people who saw a family doctor, adjusting only for age and start date. Over roughly three to four years, people on cross-sex hormones died at four to nine times the comparison rate. They had much higher rates of suicide, other violent or accidental deaths, cancer and heart disease. The authors blame stigma and gaps in care and say hormones are not the cause. But the study measured neither. A single prescription is a loose way to decide who is trans, and may include people treated for other illnesses. The results show more deaths in this group but cannot explain why.
Key findings
- شملت الدراسة 9,713 شخصاً مسجلين إناثاً (متوسط العمر 25، تمت متابعتهم نحو 3 سنوات) و19,347 مسجلين ذكوراً (متوسط العمر 36، تمت متابعتهم ما يقارب 4 سنوات)، وُجدوا عبر وصفات الهرمونات المغايرة من 2012 إلى 2023.
- قورنوا بنحو 20 مليون شخص زاروا طبيب أسرة، طوبقوا بالعمر وشهر البدء وسنته في الدراسة فقط.
- كانت الوفيات لأي سبب أعلى بنحو 9 أضعاف في المجموعة المسجلة إناثاً ونحو 4 أضعاف في المسجلة ذكوراً؛ ومات 0.6% و5.5% أثناء الدراسة.
- كان الانتحار أعلى بنحو 12 ضعفاً في المجموعة المسجلة إناثاً و4 أضعاف في المسجلة ذكوراً؛ وكانت الوفيات العنيفة أو العرضية الأخرى أعلى بنحو 9 و3 أضعاف.
- كانت وفيات السرطان أعلى بنحو 8 و5 أضعاف، ووفيات القلب والأوعية الدموية بنحو 16 و3 أضعاف، مع أكبر الفجوات في الأعمار الأكبر.
- في المجموعة المسجلة ذكوراً، انخفض خطر الانتحار الإضافي كلما طالت مدة بقاء الناس على الهرمونات؛ وفي المجموعة المسجلة إناثاً، ازداد خطر الوفاة الإضافي الإجمالي بمرور الوقت.
- يعزو المؤلفون ذلك إلى ضغط كون الشخص من أقلية وعوائق الرعاية الصحية، ويقولون إنه لا ينبغي لوم الهرمونات على الوفيات، لكن الدراسة لم تقس أياً منهما.
Abstract
BACKGROUND: Transgender and gender diverse ('trans') people may be at increased risk of mortality, particularly from external causes, however, large-scale, population-based evidence remains scarce. This study aims to document all-cause and cause-specific mortality among trans people. METHODS: We source administrative data on healthcare and death records (2012-2023) from all Australians aged 15 years and above. Individuals identified as trans (initiated gender-affirming hormone therapy) were matched to the general population who visited a General Practitioner during the same period. Cox proportional hazard models were used to estimate all-cause and cause-specific mortality risk for trans people, with models estimated separately for people who were assigned female sex at birth (AFAB) and people who were assigned male sex at birth (AMAB). Inverse probability weights were applied to balance comparators on month-year and age at entry. Results were additionally stratified by age (15-24, 25-39, 40-59, and ≥60 years). FINDINGS: A total of 19,347 trans people AMAB (mean age 36.2 years; median follow-up 3.7 years) and 9713 trans people AFAB (mean age 25.4 years; median follow-up 2.8 years) were matched with 9,879,037 general population males (mean age 44.4; median follow-up 11.3 years) and 10,282,651 general population females (mean age 44.9; median follow-up 11.4 years), respectively. All-cause mortality was significantly higher for trans people AMAB [HR = 3.89 (95% CI 33.65; 4.14)] and trans people AFAB [HR = 9.03 (95% CI 6.90; 11.83)]. For trans people AFAB, cause-specific mortality was elevated for cardiovascular disease [HR = 16.39 (95% CI 8.56; 31.37)], suicide [HR = 11.73 (95% CI 6.94; 19.80)], external causes [HR = 8.95 (95% CI 5.69; 14.09)], and cancer [HR = 7.62 (95% CI 4.61; 12.61)]. For trans people AMAB, cause-specific mortality was elevated for cancer [HR = 5.12 (95% CI 4.67; 5.61)], suicide [HR = 4.02 (95% CI 3.12; 5.18)], external causes [HR = 2.78 (95% CI 2.31; 3.35)], and cardiovascular disease [HR = 2.60 (95% CI 2.22; 3.05)]. Older trans people had more pronounced excess risk from cancer and cardiovascular disease. For trans people AFAB, excess mortality from suicide and external causes increased with age, whereas for trans people AMAB relative risks were higher in young and middle adulthood. INTERPRETATION: In this nationwide cohort study, trans Australians experienced substantially elevated mortality risk. Tailored policy responses are needed to address premature mortality in trans populations. FUNDING: University of Melbourne McKenzie Fellowship (2025MCK182); the National Health and Medical Research Council (2008956); Viertel Charitable Foundation; University of Melbourne Faculty Research Grant (2025FRG19).
Conclusion
In this nationwide cohort study, trans Australians experienced substantially elevated mortality risk. Tailored policy responses are needed to address premature mortality in trans populations, including cardiovascular disease and cancer prevention (risk-factor management, screening uptake and continuity of care), alongside strategies to prevent deaths from external causes, including suicide. The authors state that the elevated mortality should not be interpreted as attributable to gender-affirming hormone therapy itself, and that policy responses should address the social factors, such as stigma and discrimination, that they argue perpetuate these inequities.