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)