A retrospective cohort study of 4,568 patients found that trans-identified males taking estrogen had an all-cause mortality rate 80% higher than that of men in the general population.

A retrospective cohort study of 4,568 patients at an Amsterdam gender clinic found that trans-identified males taking estrogen had an all-cause mortality rate 80% higher than that of men in the general population (Standard Mortality Ratio [SMR] 1.8). Cause-specific mortality was elevated for cardiovascular disease, lung cancer, HIV-related disease, and suicide. No decrease in mortality risk was observed across the five decades studied.

^{de Blok, C. J. M., Wiepjes, C. M., van Velzen, D. M., Staphorsius, A. S., Nota, N. M., Gooren, L. J. G., Kreukels, B. P. C., & den Heijer, M. (2021). Mortality trends over five decades in adult transgender people receiving hormone treatment: A report from the Amsterdam cohort of gender dysphoria. The Lancet Diabetes & Endocrinology, 9(10), 663-670. https://doi.org/10.1016/S2213-8587(21)00185-6}