Does Gender-Identifying Hormone Therapy Affect Your Risk of Type 2 Diabetes?

Transfeminine (TF) people Type 2 diabetes According to the results of the cohort study, it was compared with cisgender females (CF) (T2D). However, the corresponding differences in T2D risk cannot be identified when compared to cisgender males (CM), and there is evidence that T2D in TF or transmasculine (TM) individuals is due to gender-verifying hormone therapy (GAHT). Almost none.

The manuscript was published online Journal of Clinical Endocrinology & Metabolism.

“Our findings provide some reassurance that gender-verifying treatments do not increase risk. [T2D]However, our analysis is not designed to assess more subtle asymptomatic changes. For this reason, healthcare providers need to continue to monitor the metabolic status of individuals undergoing gender-verifying treatment. ” Said Noreen Islam, MD, MPH, Research Author of Emory University School of Medicine in Atlanta, Georgia.

Nearly one million people in the United States have identified it as transgender, and an ever-increasing number of people report identifying it as transgender and gender diversity (TGD). As healthcare providers are more likely to encounter TGD patients during their practice, it is becoming increasingly important to better understand the health problems faced by these individuals, the authors explained.

One of the priorities of TGD health research is to elucidate the metabolic changes induced by GAHT. “There is evidence that GAHT can affect glucose metabolism and body weight, but how these changes affect risk. [T2D] It’s unclear, “they added.

To assess the occurrence of T2D in a cohort of people with TGD undergoing GAHT, researchers evaluated migration results and data from gender studies (STRONG). This cohort consists of electronic health records of TGD patients being treated with three Kaiser Permanente medical systems in California and Georgia.

TGD patients were matched with up to 10 male and 10 female cisgender patients based on race / ethnicity, date of birth, and other characteristics. All study participants were at least 18 years of age on the date of the index and included data reported between 2006 and 2014 in the analysis. The follow-up period has been extended until the end of 2016.

Of the 5002 TGD individuals included, 2869 (57%) were TFs and 2133 (43%) were TMs. Patients were matched against 28,300 CF and 28,258 CM patients, and 20,997 CF and 20,964 CM referents, respectively.

Analysis revealed:

• Members of the TM cohort were on average younger than TF members, with more than half of the participants (54% in TF and 60% in TM) being non-Hispanic Caucasians.
• The percentage of participants with a normal body mass index at baseline was about the same in the TF and TM cohorts (36% vs. 34%).
• About 32% of TFs and 24% of TM individuals used GAHT on or before the index date.
• Type 2 diabetes and type 2 in the TF cohort compared to CF referents with odds ratios (OR) and HR estimates of 1.3 (95% CI, 1.1-1.5) and 1.4 (95% CI, 1.1-1.8), respectively. Both diabetes were more common.
• Of the 287 TF patients, 175 (61%) and 77 of the 131 TM patients (59%) were diagnosed with T2D at baseline (before the index date), and the rest had diabetes at some point after the index date. I developed.
• No significant difference was observed in the prevalence or incidence of T2D in both TGD individuals with evidence of receipt of GAHT across the rest of the comparison group.
• Previous studies have investigated the effects of GAHT on laboratory markers of insulin resistance and glucose metabolism. According to one study, GAHT can induce insulin resistance in individuals with TM and TF, but only if insulin levels remain within the physiological range. An additional study reported that “people with TF experienced increased glucose utilization after the start of GAHT, but the same results from TM study participants showed no discernible change from baseline.” , Both studies included a small sample size.

“Published literature shows that glucose metabolism and insulin resistance measurements do not appear to be adversely affected by testosterone in TM individuals, but may be affected by estradiol therapy in TF individuals. “The researchers explained. They continued, “Despite these observations, the clinical significance of the reported association is unclear and small GAHT-related changes in laboratory parameters may not be converted into an overt risk of type 2 diabetes. There is sex. “

Current analysis did not collect data at specified intervals and the algorithm used did not make a clear distinction between T2D and type 1 diabetes (T1D), but excluded cases of T1D-specific diagnostic codes. rice field. Some misclassifications may have occurred, indicating the limits of the study.

It also did not include data on other risk factors for type 2 diabetes, such as family history, socioeconomic status, and adversity childhood experience. Previous studies have shown that sexual and gender minority stress is associated with an increased incidence of cardiovascular disease, but the data show a stressful experience with type 2 diabetes and poor glycemic control. Associated with.

“Given the apparent lack of association between GAHT receipt and T2D incidence in our study, additional studies have hypothesized effects of gender-based minority stress, We need to focus on the interaction of TGD with metabolic risk factors that are relevant to people’s lifestyles, “they conclude. It guarantees future larger and more detailed studies with longer follow-up periods.

reference

Is there a link between hormone use in Islam N, Nash R, Zhang Q and other transgender people and the incidence of diabetes? Data from the STRONG cohort. J Clin Endocrinol Metab. Published online on November 30, 2021. doi: 10.1210 / clinem / dgab832