Health Risks for Transgender Individuals Using Estrogen
A recent study indicates that biological males who identify as transgender and use estrogen to enhance their femininity face several health risks, including infertility, diabetes, and increased chances of certain cancers, ultimately leading to a higher risk of early mortality.
This study, featured in the journal Discover Mental Health earlier this month, outlines both known and newly identified negative consequences of estrogen usage. While proponents argue that failing to receive such medical care might lead to suicidal tendencies, some research suggests that the incidence of suicidal thoughts may actually rise among those on these treatments.
“Recent systematic reviews indicate that the evidence supporting benefits is often of low certainty, while risks like infertility have been recognized for some time,” the authors, led by Lauren Schwartz from Oklahoma City Psychiatry, note.
Even with established risks remaining inadequately documented in long-term studies, “new evidence outlined in this paper suggests further potential risks that are less understood,” they emphasize. This lack of information hampers both patients and healthcare providers in their assessments of risks and management strategies.
Identifying Well-Known Risks Associated with Estrogen
Unsurprisingly, the injection of feminizing hormones like estrogen can lead to reduced fertility, which the authors cite as a significant known risk. Although some individuals report maintaining sperm production, estrogen typically results in a higher occurrence of sperm abnormalities, making conception challenging.
The research also highlights the increased cardiovascular risks experienced by males on estrogen compared to their cisgender counterparts. For instance, one review indicated that transgender females had a 2.2 times higher occurrence of venous thromboembolism compared to other males. Alarmingly, another study noted that this risk escalated significantly with prolonged estrogen use, becoming five times higher after two years and ten times higher after six years.
Additionally, transgender individuals face a 30% heightened risk of stroke relative to other males.
There’s also evidence suggesting that estrogen may impair cognitive functions. A long-term study indicated that older men on estrogen scored lower in information-processing speed and episodic memory than matched controls in education and age.
Emerging Risks Linked to Estrogen Use
The study sheds light on lesser-known effects, emphasizing the need for more in-depth research. A comprehensive Dutch study spanning five decades found that the mortality risk for transgender women on hormones was notably higher than that of the general population. Deviations in survival rates began just a few years after starting hormone treatments, with leading causes of death including heart disease, cancer, and suicide.
Previous research tracking 966 transgender males revealed a mortality rate 51% above that of the general population.
The study also highlights concerns that men using estrogen may be more susceptible to autoimmune disorders like rheumatoid arthritis and may face a higher likelihood of developing diabetes due to insulin resistance.
Even those who have had testicular removal aren’t exempt from health risks: studies indicated that they experienced testicular cancer at a rate 26.5 times greater than that of the average population. This might be tied to long-term hormone treatment.
Moreover, men on estrogen may also see an increased risk of breast cancer, with one systematic review pointing out a 22.5 times higher incidence compared to those not on the hormone.
There are even indications that estrogen use might lead to a decrease in brain size, although this remains a somewhat controversial finding based on limited studies.
The authors do not claim to have definitively proven these risks, concluding that there is an “urgent need” for further research, particularly with systematic long-term follow-ups.
In a related development, the Supreme Court recently upheld a Tennessee law that bans experimental transgender medical treatments for minors, often referred to as “gender-affirming care.” Additionally, last month, a report from the Department of Health and Human Services stated there is “extremely weak evidence” supporting the benefits of puberty blockers, cross-sex hormones, or surgeries for minors experiencing gender dysphoria.
