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As doctors consider how young is too young to give sex hormones to children who say they are transgender, more research is linking gender-affirming hormone therapy with an increased risk of strokes, blood clots and heart attacks.

A new analysis found that trans women — people born male who identify as female — on hormone therapy had more than twice as many strokes as women, and nearly twice as many strokes as men over the study period. Trans women also had five times as many deep-vein blood clots compared to non-trans women and men.

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Trans men — those born female who identify as male — who received hormones had a three-fold higher risk of heart attack compared with women.

“In light of our results, we urge both physicians and transgender individuals to be aware of this increased cardiovascular risk,” study author, Dr. Nienke Nota, of Amsterdam University Medical Center, said in a statement.

Still, Nota said the benefits of cross-sex hormone therapy outweigh the risks. For people who identify with the opposite gender, the pills, patches and injections can reduce the stress and trauma of watching their bodies evolve into the “wrong” sex.