Biological males who identify as transgender and take estrogen in order to appear female face myriad health risks, from infertility to diabetes, to testicular and breast cancer, and ultimately to early death, according to a new study.
The study, published in the academic journal Discover Mental Health earlier this month, highlights adverse reactions to estrogen, both health risks that have been widely known and “newly identified adverse outcomes.” While activists claim people who identify as transgender may commit suicide if they cannot access these medical interventions, which they call “gender-affirming care,” some studies actually suggest that suicidal thoughts increase among those taking these drugs.
“Several recent systematic reviews have found the evidence of benefit to be of low or very low certainty, while some risks, such as infertility, have long been recognized,” the authors, led by Lauren Schwartz of Oklahoma City Psychiatry, write.
While even these better-known risks lack “systematic, long-term data,” “the emerging evidence reviewed in this paper points towards additional, less-understood and less-investigated potential risks,” the authors warn. “Consequently, both patients and health care providers are deprived of clinically crucial information necessary for effective risk assessment and management.”
It may come as little surprise that injections of the feminizing hormone estrogen may make men less fertile, and the authors cite fertility risks as the first of the “previously recognized risks.” While some studies report that some patients preserved “spermatogenesis” (the production of sperm cells), estrogen often “causes higher proportions of sperm abnormalities,” such as low sperm count and poor sperm movement. These would make it difficult for men to conceive a child.
The study also cites research that “consistently indicates” that males taking estrogen and other feminizing hormones “face increased cardiovascular risks” compared to other men.
A review of many studies involving over 15,000 males who identified as female found they experienced venous thromboembolism (a blood clot in the veins) 2.2 times more than other men. Another study found that the risk of such clots became 5.1 times higher for men taking estrogen for two years or more and increased to 10 times higher after six years.
Another study found that men who identify as transgender face a 30% higher risk of stroke than men who do not.
Some studies also suggest that estrogen may worsen men’s thinking ability. A study with a long-term follow-up (average 25.8 years) found that men (ages 56-84) who had been taking estrogen and other feminizing hormones “had lower scores” than other men and women “(matched in education and age) in information-processing speed and episodic memory.”
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The study also discussed lesser-known side effects that deserve more research.
A long-term Dutch study tracking men who identified as transgender over five decades found that “the all-cause mortality risk of transgender women on hormones was much higher than the general population.” The survival odds “started to deviate from general population men or women within a few years of starting” to take estrogen and other hormones. The major causes of death included heart disease (21%), cancer (32%), infection-related disease (5%), and suicide (7.5%).
An earlier study following 966 men who identified as transgender “found a mortality rate 51% higher than in the general population.”
The study also notes evidence that men taking estrogen face a greater risk of autoimmune diseases such as rheumatoid arthritis. It also cites evidence that estrogen in males might increase the risk of diabetes, as the hormone may cause insulin resistance.
Even men who have one or both of their testicles removed face the risk of testicular cancer, the study found. One study found that men who had at least one testicle removed got diagnosed with testicular cancer at a rate 26.5 times higher than the general population. The authors of that study hypothesized that this might result from “long-term pretreatment with hormones or [drugs that attempt to block the natural onset of puberty].”
Men taking estrogen may also face an increased risk of breast cancer. A systematic review found that these men experience breast cancer 22.5 times as frequently as men who do not take estrogen.
The study also noted that estrogen may make brain size decrease, though the studies showing this phenomenon had small sample sizes.
The authors do not claim to have definitively proven these harms. They conclude by saying there is an “urgent need” for more studies, particularly with “systematic long-term follow-up.”
Last week, the Supreme Court upheld a Tennessee law prohibiting experimental transgender medical interventions for minors, euphemistically referred to as “gender-affirming care.”
Last month, the Department of Health and Human Services published a report finding that “there is extremely weak evidence that puberty blockers, cross-sex hormones, or surgeries have any benefits in children and adolescents with gender dysphoria” (emphasis original).