Estrogens don’t protect against cardiovascular death for trans women

June 13, 2009

blue_pillsOne pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don’t do anything at all…

Medical News TODAY carries a report (link here) on a presentation given to the Endocrine Society by Henk Asscheman, MD, PhD, a clinical researcher at Vrije University in Amsterdam.

A study undertaken by Dr Asscheman and his team suggests that, while long term estrogen use does not protect trans women from death due to cardiovascular disease, neither does it appear to raise our overall death rate.

It’s hard not to conclude that, if the transphobic bigots don’t kill us, then our meds probably will.

Asscheman and his colleagues followed up 1,330 transsexuals who received cross-sex hormone therapy for an average of about 15 years. They compared the number of deaths in their study population with the expected death rate by age and sex in the general population.

Male-to-female transsexuals receiving estrogens were more likely to die of heart disease and stroke between the ages of 40 and 64 than men of the same age in the general population. They had 1.8 times the risk of dying of coronary artery disease and twice the risk of dying of a stroke.

However, Asscheman said they have not yet analyzed how many of the transsexuals smoked cigarettes, a major risk factor for heart disease. In their clinical experience, more male-to-female transsexuals smoke than does the average population, he said.

“This increased cardiovascular death rate adds to recent research [in women] that estrogens are not cardioprotective and suggests that estrogen-alone treatment may even increase the risk of cardiovascular disease, especially in smokers,” Asscheman said.

Possibly the most disturbing paragraph of the Medical News TODAY report is this:

Overall, the male-to-female transsexuals receiving estrogen had a 46 percent higher death rate than would be expected in the general population, but this was due to causes that the authors considered unrelated to sex hormone treatment. Among the 25- to 39-year-olds, their higher death rate was due to increased numbers of suicide, drug-related deaths and AIDS. The suicide rate also was higher (eight times higher than expected) in the 40- to 64-year-old male-to-female transsexuals. Transsexuals already are known to have a higher rate of suicide before starting hormone therapy, and estrogen use is not associated with increased suicide rates in women, Asscheman said.

There’s no question that there’s very little empirical medical evidence available on the various specific health risks faced by trans women. And although these results are as depressing as they’re scary as they’re alarming – we’re at twice the risk of dying from heart disease or a stroke and eight times more likely to commit suicide – there’s no doubt in my mind that much, much more research in this area is needed urgently.

Finally, it should go without saying that all the research in the world is ultimately useless if healthcare systems fail to provide suitable, adequate and accessible services and support for us.

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Cross-posted at Questioning Transphobia

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