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Comment by elhudy | Hacker News Reader

While this is certainly an interesting take, it seems like you're cherry-picking data to tell a story that ends in the following conclusion:

>you'd expect a well-off socially accepted trans woman on HRT to live longer than a genetically identical cis man. She has an improved immune system due to lower testosterone...

I don't think this is a very factual conclusion. When it comes to the long term physical and mental outcomes of transgender hormonal therapy, we simply don't know. If we don't know the long term implications of infusing our bodies with synthetic hormones, then I would consider that to be a health risk.

While I fully support adult's decisions to put whatever chemicals they want to into their bodies, hormonal therapy seems like a health risk and is certainly, by any definition of the term, unnatural. I don't believe I am a bigot because of this opinion, either.

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I was curious about trans people and the health risks of HRT because I have some trans people in my life as of the past few years. When I looked into it I found that there is an association between testosterone levels and mortality along with vulnerability to illness. That did indeed lead me to a particular point of view on the subject and that point of view runs contrary to the common narrative that cross sex hormones are always bad. It's my counter-narrative I suppose.

Not that you asked but in matters of gender it seems like even the most reasonable people seem to fall back on gut feelings over facts. One of those "gut feelings" seems to be that taking cross sex hormones is always or obviously bad for your health. I think it's fascinating to note the fact that much of the literature on the topic only suggests that too much of any sex steroid is bad and in particular testosterone shortens lifespan possibly because it is a weak immunosuppressant. Maybe taking estrogen offsets some of the gains of having low testosterone concerning lifespan but considering that females tend to outlive intact males but not eunuchs it seems likely that the downsides of estrogen are gentler overall.

Insofar as long term consequences, trans women have now been taking HRT since the 1940s so I suspect we'll be seeing some cohorts showing up in published studies more and more. Anecdotally trans women like April Ashley who transitioned in the 1950s, and died this year in her late 80s, and Wendy Carlos who transitioned in the 1970s and is still alive seem to be doing fine. (April Ashley was a very fascinating person: https://www.youtube.com/watch?v=tjA9zdIYruU)

> When it comes to the long term physical and mental outcomes of transgender hormonal therapy, we simply don't know.

Correction: you don't know anything about the long-term physical and mental outcomes for patients on HRT HRT, because you did not do any kind of research into it - you wouldn't need to use adjectives as vague as "unnatural" or "synthetic" otherwise.

Correction: we don't know anything about the long-term physical and mental outcomes for patients on HRT. Modern therapies have only been in use since the early 2000's

I am sorry that this fact upsets you and puts you into a hyper-defensive mode but that does not make it any less of a fact. Here is just one of several real studies confirming this fact with regards to cardio health.

"Gender-affirming or cross-sex hormone therapy is integral to the management of transgender individuals yet our appreciation of the effects of such hormones on cardiovascular health is limited. Insights into vascular pathophysiology and outcomes in transgender people receiving sex steroids could be fundamental in providing better care for this population through the management of cardiovascular risk and more broadly advance our understanding of the role of sex and gender in vascular health and disease. In addition, there is a need to understand how gender-affirming hormone therapy impacts cardiovascular disease risk and events as transgender individuals age...Current research about vascular outcomes in adults receiving hormonal therapy is limited by the absence of large cohort studies, lack of appropriate control populations, and inadequate data acquisition from gender identity services. Existing epidemiological data suggest that the use of estrogens in transgender females confers an increased risk of myocardial infarction and ischemic stroke." [1]

[1]https://pubmed.ncbi.nlm.nih.gov/31656099/

Why are you being so antagonistic? You don't really know what this commenter has or hasn't researched on this topic. Please be more polite when expressing disagreement, and focus on the facts at hand, not an imagined adversary.

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