Dhejne et al. (2011, Swedish cohort, long-term post-sex reassignment): Sex-reassigned individuals had substantially higher overall mortality (adjusted HR ~2.8), suicide (HR ~19), suicide attempts, and psychiatric morbidity vs. matched controls. Cardiovascular death also elevated. Effects persisted after adjustments for prior psychiatric issues. Both MtF and FtM included.
de Blok et al. (2021, Dutch nationwide, 5 decades): Transgender women on hormones had higher mortality than general population men (SMR 1.8) and women (SMR 2.8). Causes included cardiovascular disease, lung cancer, HIV-related, and suicide. No clear improvement trend over decades. Trans men also showed elevation (different pattern, more non-natural causes). Median hormone exposure in decedents was long (~16 years for trans women).