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Incident Diabetes Risk is Not Increased in Transgender Individuals Using Hormone Therapy: An Observational Study From the ACOG Study

30 Pages Posted: 1 Sep 2021

See all articles by Daan van Velzen

Daan van Velzen

University of Amsterdam - Division of Endocrinology

Chantal Wiepjes

University of Amsterdam - Division of Endocrinology

Nienke Nota

University of Amsterdam - Division of Endocrinology

Daniel van Raalte

University of Amsterdam - Division of Endocrinology

Renée de Mutsert

Leiden University Medical Centre - Department of Epidemiology

S. Simsek

University of Amsterdam - Division of Endocrinology

Martin den Heijer

University of Amsterdam - Division of Endocrinology

More...

Abstract

Background: In trans women receiving hormone therapy, body fat and insulin resistance increases, with opposite effects in trans men. These metabolic alterations may increase or decrease the risk of developing type 2 diabetes in trans women and trans men, respectively. Currently, there is no data on the incidence of type 2 diabetes in transgender individuals.

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 was available, the occurrence of diabetes was deferred from the first dispense of a glucose-lowering agent. Standardized incidence ratios (SIR) were computed for trans women and trans men in comparison with respectively men and women from the general population.

Findings: 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). 


Interpretation: Despite studies reporting an increase in insulin resistance in feminizing hormone therapy and an increase in insulin sensitivity in masculinizing hormone therapy, the incidence of type 2 diabetes in transgender individuals after initiation of hormone therapy was not different compared to the general population. Earlier studies on the effect of hormone therapy on insulin sensitivity in transgender individuals might have revealed specific effects of cyproterone acetate rather than effects of estradiol.

Funding: None to declare.

Declaration of Interest: None to declare.

Ethical Approval: The study was approved by the Medical Ethics Committee of the Amsterdam University Medical Centre

Keywords: Diabetes mellitus, transgender endocrine care, hormone therapy

Suggested Citation

van Velzen, Daan and Wiepjes, Chantal and Nota, Nienke and van Raalte, Daniel and Mutsert, Renée de and Simsek, S. and den Heijer, Martin, Incident Diabetes Risk is Not Increased in Transgender Individuals Using Hormone Therapy: An Observational Study From the ACOG Study. Available at SSRN: https://ssrn.com/abstract=3915417 or http://dx.doi.org/10.2139/ssrn.3915417

Daan Van Velzen (Contact Author)

University of Amsterdam - Division of Endocrinology ( email )

Amsterdam
Netherlands

Chantal Wiepjes

University of Amsterdam - Division of Endocrinology ( email )

Amsterdam
Netherlands

Nienke Nota

University of Amsterdam - Division of Endocrinology ( email )

Amsterdam
Netherlands

Daniel Van Raalte

University of Amsterdam - Division of Endocrinology ( email )

Amsterdam
Netherlands

Renée de Mutsert

Leiden University Medical Centre - Department of Epidemiology ( email )

Albinusdreef 2
Leiden, South Holland 2333 ZA
Netherlands

S. Simsek

University of Amsterdam - Division of Endocrinology

Amsterdam
Netherlands

Martin Den Heijer

University of Amsterdam - Division of Endocrinology ( email )

Amsterdam
Netherlands