On the occasion of the congress Infogyn 2022Dr Marie D’Assigny, doctor at the University Hospital of Poitiers, recalled that ” due to a greater risk of death than in the general population, transgender people on hormone therapy should benefit from reinforced follow-up, particularly on the cardiovascular or oncological level »[1].
Multiple risks
Transgender women, that is, people born male, are at risk for breast cancer. And this risk increases after a relatively short period of hormone therapy “. One study showed an incidence 46 times higher than that observed in men of the same age, but three times lower than in women.
Transgender women also remain at risk of prostate cancer. For their part, transgender men are at risk of uterine cancer because ” testosterone causes thinning of the endometrium which may be responsible for dysplasia[2] ».
In terms of cardiovascular pathologies, transgender people and more particularly transgender women must be considered “ high risk, and in some cases even very high risk “. Their blood pressure should be closely monitored, as it tends to increase with hormone therapy.
Bone density should also be monitored, due to the risk of osteoporosis. especially in patients who stop hormone therapy after gonadectomy ».
Increased mortality
Last year, a study looked at mortality and factors of death in transgender people on hormone therapy[3]. « More than 4,500 transgender people, the majority of them in male-to-female transition (MtF), were included between 1972 and 2018 ».
The researchers found a mortality twice as high among transgender people, compared to the general population “. Indeed, they found a death rate of 10.8% among transgender women, and 2.7% among transgender men. Thus, the mortality of transgender women is three times higher than that of women in the general population. A trend observed over the five decades of monitoring.
The study indicates that the main causes of death are cardiovascular diseases, especially in transgender women, lung cancer, ” potentially due to more frequent smoking in this population », HIV-related illnesses and suicide (cf. Gender: the “medical transition” associated with an increase in underage suicides).
In September, the High Authority for Health (HAS) published a framework note on the care of transgender people (cf. Transgender people: HAS recommendations under development). New recommendations are expected next year.
[1] D’assigny M, Transgender: a current reality, Endocrine management and monitoring, Infogyn 2022, presentation of October 6, 2022, Pau, France
[2] lesion related to an abnormality occurring during the development of a tissue or an organ
[3] JM de Blok C, Wiepjes C, Velzen DM, Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria, The Lancet Diabetes and Endocrinolyoct 2021, Vol 9, Issue 10, p663-670.
Source : MedScape, Vincent Richeux (16/11/2022)