2927 trans women and 1641 trans men on hormones tracked for 57,517 person-years. Trans women died at 10.8% rate with SMR 1.8 versus men and 2.8 versus women. Trans men died at 2.7% rate with SMR 1.8 versus women and 1.2 versus men. Trans women suffer excess deaths from cardiovascular disease, lung cancer, HIV, and suicide. Trans men suffer excess non-natural deaths. No decreasing mortality trend observed across five decades. Elevated risk persists regardless of hormone treatment type. Excess mortality indicates need to monitor lifestyle factors and comorbidities. 317 trans women and 44 trans men died during follow-up. Study excludes those under 17, puberty blocker users, and alternators. Data linked to national statistics for age-sex-period standardization.