Sweden, twenty-two years of registries and 9,038 adults with a diagnosis of gender dysphoria. Of them, 211 died. Compared with the cisgender population, their risk of death was nearly double. A new national study published in eClinicalMedicine, the clinical medicine journal of the Lancet group, puts figures on one of the most persistent health gaps: premature mortality among people with gender incongruence.
Nine thousand people followed for two decades
The team, led from the Department of Medical Sciences (Clinical Psychiatry) at Uppsala University, with the participation of the Karolinska Institute, the Norwegian Institute of Public Health and Queen Mary University of London, tracked in the Swedish national registries all adults with a diagnosis of gender dysphoria —identified with ICD-10 codes— between 2001 and 2023.
They found 9,038 people: 4,181 trans women (male sex assigned at birth) and 4,857 trans men (female sex assigned at birth). Each one was compared with about ten cisgender people of the same sex, the same age and the same county of residence, a matching that makes it possible to isolate more cleanly the effect of gender identity on health. The mean age of the cohort is young, 25 years, an important detail when reading the results.
Twice the mortality, but with different patterns
The risk of death from any cause was 90% higher than in the cisgender group (mortality rate ratio, MRR, of 1.9; 95% confidence interval: 1.7-2.2). The interesting detail comes when separating by sex assigned at birth: trans women showed a risk 2.3 times higher than cisgender women and 1.6 times higher than cisgender men; trans men, 2.1 times higher than cisgender women and 1.7 times higher than cisgender men.
And the causes are not distributed equally. Among trans women, external causes stood out —suicide, homicide and accidental poisoning— and “ill-defined” diseases, with a four- to five-fold excess (4.9 to 5.5), in addition to neuropsychiatric disorders. Among trans men the excess was concentrated in tumours (2.4 times compared with cisgender women and 1.8 compared with cisgender men), respiratory diseases and infectious or parasitic diseases, although in these last two groups the number of cases was so low that the authors urge caution.
Six and nine years of life lost
Translated into years of potential life lost, the study calculates an average of 6.3 more years for trans women compared with cisgender men and 9.0 more years for trans men compared with cisgender women. Projected onto the whole group, the excess would amount to tens of thousands of years of life: about 36,800 in trans women and about 43,700 in trans men, taking cisgender women as the reference.
The “ill-defined” deaths: a clue about stigma
One of the most striking findings is the excess mortality attributed to ill-defined diseases in trans women, a category uncommon in this type of study. The authors point to an administrative and social explanation: part of those deaths could in fact be external causes that were not reclassified because of delays in forensic investigation, mismatches in identification numbers after a legal gender change, or systemic barriers and stigma during post-mortem investigations. They also note that neuropsychiatric disorders —which include alcohol use disorders and depressive or bipolar disorders— can end up coded as external causes.
The study frames all of this within so-called minority stress: sustained exposure to discrimination, harassment and violence, documented as high in European countries, keeps a known relationship with a higher risk of suicide and with worse cardiovascular and oncological health.
What the study does not say
This is an observational study with registry data: it describes inequalities, it does not prove causes. It does not allow the conclusion that gender-affirming hormone therapy is responsible for the excess. In fact, the authors recall that the bioidentical estradiol that today replaces older formulas is not associated with more cardiovascular disease, and that androgen suppression could explain why trans women do not show more tumour mortality than cisgender men, given the protective effect against prostate cancer. Data on tobacco and alcohol are also missing, only people who have reached the health system are included —which leaves out those who have not been diagnosed— and the youth of the cohort probably underestimates the typical causes of older ages.
What the authors are asking for
Beyond the statistical snapshot, the work defends three ideas: public health interventions aimed specifically at this group, a review of death certification processes and continued follow-up of the cohort as it ages. The conclusion is a starting point: the data serve to monitor trends, not to close the debate on the biological, behavioural and social mechanisms behind each excess.
Source: Nationwide estimates of all-cause and cause-specific mortality among individuals with gender dysphoria in Sweden, 2001-2023: a register-based cohort study. Clark KD, White RA, Jackson SS, Skalkidou A, Frisell T, Papadopoulos FC. eClinicalMedicine (Lancet group) 2026;98:104088. DOI: 10.1016/j.eclinm.2026.104088.
Read the publication: eClinicalMedicine.
Article published on dosier.es. Image generated with artificial intelligence (marta ai → marta.syf.es).
