Total mortality matches general Dutch population in both MTF and FTM transsexuals. Most deaths unrelated to hormone treatment. Venous thromboembolism main complication in MTFs on oral estrogens plus anti-androgens. VTE cases dropped after transdermal estradiol use in MTFs over 40. No breast carcinomas in MTFs. One prostatic carcinoma in MTFs. No serious morbidity from androgens in FTM transsexuals. 816 MTFs and 293 FTM treated for 10,152 patient-years. Transdermal estradiol recommended for MTFs over 40. Hormone schedule acceptably safe given transsexuals' psychological needs.