Gender-affirming Hormone Therapy and Risk of Diabetes in Transgender Persons

Tangpricha, Vin

doi:10.1210/clinem/dgac060

Cited by 6 publications

(5 citation statements)

References 8 publications

(9 reference statements)

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“…Neither the Amsterdam cohort [36] nor the Strong cohort [37] have reported differences in baseline prevalence and the incidence of diabetes in transgender people who initiated GAHs compared with reference cisgender male and female controls. However, when examining the incidence of diabetes in transwomen, in both those taking and those not taking GAHs, there was an increased incidence and prevalence of diabetes compared with ciswomen, suggesting the risks of diabetes may not be related to hormonal therapy [38].…”

Section: Discussionmentioning

confidence: 95%

Cardiovascular Risk Factors in Transgender People after Gender-Affirming Hormone Therapy

Sánchez-Toscano,

Domínguez-Riscart,

Larrán-Escandón

et al. 2023

JCM

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Introduction: In the last decade, healthcare for the transgender population has increased considerably in many countries thanks to depathologization movements and the easier accessibility of medical assistance. The age at which they request to start gender-affirming hormones (GAHs) is increasingly younger. The cardiovascular risk associated with hormonal treatment is a novel research field, and the published studies are heterogeneous and inconclusive. Our objective is to determine the metabolic impact of GAHs in the transgender people treated in our Gender Identity Treatment Unit. Methods: We designed a pre–post study to analyze changes in anthropometric parameters (weight and body mass index), analytical determinations (fasting blood glucose, glycated hemoglobin, and lipoproteins), and blood pressure control in the transgender population treated with GAHs in Puerta del Mar University Hospital. These variables were collected before and one year after hormonal therapy. Results: A total of 227 transgender people were recruited between 2017 and 2020, 97 (40.09%) transwomen and 136 (59.91%) transmen. The average age at which GAHs began was 18 years. Weight, body mass index, and blood pressure increased significantly in both genders. Transmen showed a more atherogenic lipid profile, with a decrease in cholesterol LDL (p < 0.001) and an increase in triglycerides (p < 0.001). The risk of developing prediabetes or diabetes did not increase one year after treatment, although non-specific alterations in carbohydrate metabolism were detected, such as an increase in glycated hemoglobin in transmen (p = 0.040) and fasting blood glucose in transwomen (p = 0.008). No thromboembolic processes or cardiovascular events were reported during the first year of treatment. Conclusion: In our setting, transgender people developed changes in their metabolic profiles in the first year after hormonal treatment. Both transmen and transwomen showed early alterations in lipid and carbohydrate metabolism, slight elevations in blood pressure, and a tendency to gain weight. This makes lifestyle interventions necessary from the beginning of GAHs.

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Section: Discussionmentioning

confidence: 95%

Cardiovascular Risk Factors in Transgender People after Gender-Affirming Hormone Therapy

Sánchez-Toscano,

Domínguez-Riscart,

Larrán-Escandón

et al. 2023

JCM

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“…Additionally, trans individuals usually have less access to preventive health care services and thus, screening for and treatment of risk factors are delayed. Until stronger evidence is available, prevention and diagnosis of diabetes and cardiovascular disease in transgender people should follow established standards of care for the cisgender population [ 74 ].…”

Section: Discussionmentioning

confidence: 99%

Glucose Homeostasis, Diabetes Mellitus, and Gender-Affirming Treatment

et al. 2023

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The transgender (trans) population includes individuals with gender identities more fittingly aligned with the opposite sex or with an alternative that transcends the classical dipole of male/female. Hormonal treatment in transgender individuals aims to suppress the secretion of endogenous sex steroids and replace them with the steroids of the desired gender. The mainstay of gender-affirming treatment in transgender males is testosterone, whereas for transgender females it is estrogen, usually combined with an anti-androgen or a gonadotropin-releasing hormone agonist if testes are present. Testosterone and estrogen are involved in carbohydrate metabolism via direct effects on skeletal muscle, liver, adipose tissue, and immune cells and indirectly through changes in body fat mass and distribution. The effect of transgender treatment on glucose tolerance is not clear. The provided conflicting results demonstrate a positive, neutral, or even negative association between exogenous testosterone and insulin sensitivity in trans men. Studies show that feminizing hormonal therapy of trans women has mainly an aggravating effect on insulin sensitivity. The existing evidence is not robust and further research is needed to investigate the relationships between body fat distributions, muscle mass, and glycemia/insulin resistance in transgender people under hormonal therapy.

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“…12 Whether such changes in insulin resistance parameters would definitely translate to increased risk of type 2 diabetes remains largely uncertain, particularly given the relatively short duration of follow-up and/or retrospective nature of studies. 13,14 Nevertheless, the evidence points to increased risk of metabolic syndrome, as shown in a two-year prospective study with development in up to 17% of participants, particularly in those with co-existing psychiatric morbidity. 15 There are no controlled studies in transgender subjects with diabetes to look at the impact of GAHT on glycaemic control, nor are there data on the prevalence of diabetes among transgender populations.…”

Section: Effect On Glycaemiamentioning

confidence: 99%

“…One case control study reported increased risk of type 2 diabetes in transwomen compared to the general population 12 . Whether such changes in insulin resistance parameters would definitely translate to increased risk of type 2 diabetes remains largely uncertain, particularly given the relatively short duration of follow‐up and/or retrospective nature of studies 13,14 . Nevertheless, the evidence points to increased risk of metabolic syndrome, as shown in a two‐year prospective study with development in up to 17% of participants, particularly in those with co‐existing psychiatric morbidity 15 …”

Section: Effect On Glycaemiamentioning

confidence: 99%

Metabolic consequences of gender‐affirming hormone therapy in transgender adult persons

Vloemans,

Al‐Mrayat

2023

Practical Diabetes

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As more individuals seek to align their physical characteristics with their gender identity, transgender health care is a growing medical field which is no longer the remit of a few selected clinicians. Gender‐affirming hormone therapy (GAHT) is a mainstay treatment in gender reassignment and its medium‐ to long‐term metabolic sequelae are gradually emerging. Although hampered by the scarcity of prospective controlled studies involving large diverse cohorts, evidence suggests a potential adverse impact for at least some cardiovascular disease (CVD) risk factors. If left unmanaged, this could manifest in a higher CVD events rate for this treatment group. Increased vigilance and awareness among health care professionals about the consequential risks of GAHT are important for proactive mitigation of this. Copyright © 2023 John Wiley & Sons.

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Gender-affirming Hormone Therapy and Risk of Diabetes in Transgender Persons

Cited by 6 publications

References 8 publications

Cardiovascular Risk Factors in Transgender People after Gender-Affirming Hormone Therapy

Cardiovascular Risk Factors in Transgender People after Gender-Affirming Hormone Therapy

Glucose Homeostasis, Diabetes Mellitus, and Gender-Affirming Treatment

Metabolic consequences of gender‐affirming hormone therapy in transgender adult persons

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