On average, how long does a transgender person live compared with the rest of the population? Until now, the answers were based mainly on small studies or studies from specific countries. A new nationwide study carried out in Australia, published in The Lancet Regional Health – Western Pacific, provides one of the largest datasets to date on mortality in this group. And the figures are striking: Australian transgender people have considerably higher mortality than the general population, especially from cardiovascular disease, cancer and suicide.
How the study was carried out
The researchers used the administrative health and death records of the whole of Australia between 2012 and 2023. They identified 29,060 transgender people who had started gender-affirming hormone therapy: 19,347 assigned male at birth and 9,713 assigned female at birth.
Each one was compared with the general population that had visited a general practitioner in the same period, applying statistical techniques (inverse probability weights) so that the groups were comparable by age and by the moment of entry into the study. In total, the reference groups exceeded 20 million people.
Much higher mortality
The results are compelling. All-cause mortality was notably higher in transgender people: about 4 times higher in those assigned male at birth and about 9 times higher in those assigned female at birth, compared with their general population groups.
Broken down by cause, the elevated risk appeared in all four major groups analysed: cardiovascular disease, cancer, suicide and external causes. For example, among people assigned female at birth, the risk of death from cardiovascular disease was more than 16 times higher and that of suicide almost 12 times higher than in the general population.
A pattern that changes with age
The excess mortality was not uniform. In older people, the extra risk was concentrated above all in cancer and cardiovascular disease. In younger people, by contrast, suicide and external causes weighed more heavily.
Moreover, people assigned female at birth showed an increasing risk of suicide and external causes as they grew older, whereas in those assigned male the relative risk was higher in youth and early adulthood.
What it means and what its limits are
The authors interpret these data as a sign that Australian transgender people suffer substantial premature mortality, and call for specific policies to address it.
As always in such studies, caution is advisable. It is an observational study: it does not say that hormone therapy is the cause of that excess, but rather describes a complex healthcare reality in which access to care, stigma, mental health and social inequalities all play a role. A large part of the excess is concentrated in causes related to mental health and the social environment.
Whatever the interpretation, one clinical conclusion stands out: this group needs closer medical and mental health follow-up, with particular attention to the youngest and to those carrying the greatest burden of disease.
Bibliographic reference:
Saxby K, Bailey S, Petrie D, Nolan BJ. All-cause and cause-specific mortality among transgender and gender diverse people: a nationwide cohort study in Australia. The Lancet Regional Health – Western Pacific 2026; 67: 101813. DOI: 10.1016/j.lanwpc.2026.101813.
View the publication: The Lancet Regional Health – Western Pacific.
