Incident Diabetes Risk Is Not Increased in Transgender Individuals Using Hormone Therapy

Abstract

Background In trans women receiving hormone therapy, body fat and insulin resistance increases, with opposite effects in trans men. These metabolic alterations may alter the risk of developing type 2 diabetes in trans women and trans men. We aimed to compare the incidence of type 2 diabetes of adult trans women and trans men during hormone therapy with rates from their birth sex in the general population. Methods Retrospective data from the Amsterdam Cohort of Gender Dysphoria with transgender individuals on hormone therapy between 1972 and 2018 were linked to a nationwide health data registry. Because no central registry of diabetes is available, the occurrence of diabetes was inferred from the first dispense of a glucose-lowering agent. Standardized incidence ratios (SIR) were computed for trans women and trans men in comparison with the same birth sex from the general population. Results Compared to their birth sex in the general population, no difference in the incidence of type 2 diabetes mellitus was observed in trans women (N=2585, 90 cases, SIR 0.94 95%CI 0.76–1.14) or trans men (N=1514, 32 cases, SIR 1.40 95%CI 0.96–1.92). Conclusion Despite studies reporting an increase in insulin resistance in feminizing hormone therapy and a decrease in insulin resistance in masculinizing hormone therapy, the incidence of diabetes in transgender individuals after initiation of hormone therapy was not different compared to the general population.

Glucose Homeostasis, Diabetes Mellitus, and Gender-Affirming Treatment

“…Due to conflicting research data, it is debatable whether gender-affirming hormonal therapy has an impact on this process or not. On one hand, there is evidence indicating that both trans men and women suffer more often from diabetes mellitus [ 32 ], whilst on the other hand, it has also been reported that the standardized incidence ratio is not elevated in transgender people compared with the general population [ 33 , 34 ]. Therefore, there is no clear association between hyperglycemia with cross-sex medical treatment and the possible underlying mechanisms are not fully understood.…”

Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults

“…Wierckx et al 31 reported an increased incidence of type 2 diabetes mellitus in all TGD people prior to GAHT initiation, although this may be biased by endocrine screening during the first visit at the clinic. van Velzen et al 32 recently reported that transmasculine individuals ( n = 1514; median age = 32 years, IQR = 24–49) had no difference in type 2 diabetes mellitus incidence compared with individuals of the same birth-assigned sex (i.e. general population of women).…”

“…There have been a few studies on diabetes and body composition related to feminizing GAHT. van Velzen et al 32 recently reported that transfeminine individuals ( n = 2585; median age = 48 years, IQR = 33–58) had no difference in type 2 diabetes mellitus incidence compared with individuals of the same birth-assigned sex (i.e. general population of men).…”

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

“…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.…”