In 1989, physicians Henk Asscheman, Louis J. G. Gooren, and P.L.E. Eklund published the article “Mortality and Morbidity in Transsexual Patients with Cross-Gender Hormone Treatment,” hereafter “Mortality and Morbidity,” in the journal Metabolism. The authors presented clinical data regarding patients with gender dysphoria who were actively undergoing gender-affirming hormone replacement therapy. The data highlighted frequencies of various side effects of the treatment, including high blood pressure, blood clots, mood changes, as well as varying risk percentages of osteoporosis and cardiovascular disease, as those side effects are typically common in conventional hormone replacement therapy. According to “Mortality and Morbidity,” few scientists were studying the long-term effects of estrogen and androgen treatment for transgender people at the time of publication. The retrospective study was one of the first to research the long-term effects of hormone treatments on transgender individuals and found health concerns, such as more frequent blood clots and weight gain, in those undergoing gender-affirming hormone treatment.