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.

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Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case–control study

Acta Endocrinologica ◽

10.1530/eje-13-0493 ◽

2013 ◽

Vol 169 (4) ◽

pp. 471-478 ◽

Cited By ~ 141

Author(s):

K Wierckx ◽

E Elaut ◽

E Declercq ◽

G Heylens ◽

G De Cuypere ◽

...

Keyword(s):

Myocardial Infarction ◽

Type 2 Diabetes ◽

Adverse Events ◽

Hormone Therapy ◽

Sex Hormone ◽

Men And Women ◽

Trans Men ◽

In Trans ◽

Trans Women

ObjectiveThis study evaluated the short- and long-term cardiovascular- and cancer-related morbidities during cross-sex hormone therapy in a large sample of trans persons.Subjects and methodsA specialist center cross-sectional study compared 214 trans women (male-to-female transsexual persons) and 138 trans men (female-to-male trans persons) with an age- and gender-matched control population (1–3 matching). The participants were on cross-sex hormone therapy for an average of 7.4 years. We assessed physical health and possible treatment-related adverse events using questionnaires.ResultsFive percent of trans women experienced venous thrombosis and/or pulmonary embolism during hormone therapy. Five of these adverse events occurred during the first year of treatment, while another three occurred during sex reassignment surgery. Trans women experienced more myocardial infarctions than the control women (P=0.001), but a similar proportion compared with control men. The prevalence of cerebrovascular disease (CVD) was higher in trans women than in the control men (P=0.03). The rates of myocardial infarction and CVD in trans men were similar to the control male and female subjects. The prevalence of type 2 diabetes was higher in both trans men and women than in their respective controls, whereas the rates of cancer were similar compared with the control men and women.ConclusionMorbidity rate during cross-sex hormone therapy was relatively low, especially in trans men. We observed a higher prevalence of venous thrombosis, myocardial infarction, CVD, and type 2 diabetes in trans women than in the control population. Morbidity rates in trans men and controls were similar, with the exception of the increased prevalence of type 2 diabetes.

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Change in Visceral Fat and Total Body Fat and the Effect on Cardiometabolic Risk Factors During Transgender Hormone Therapy

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab616 ◽

2021 ◽

Author(s):

Maartje Klaver ◽

Daan van Velzen ◽

Christel de Blok ◽

Nienke Nota ◽

Chantal Wiepjes ◽

...

Keyword(s):

Insulin Resistance ◽

Hormone Therapy ◽

Body Fat ◽

Visceral Fat ◽

Cardiometabolic Risk ◽

Trans Men ◽

Total Body Fat ◽

In Trans ◽

Trans Women ◽

Total Body

Abstract Introduction Excess visceral fat increases the risk of type 2 diabetes and cardiovascular disease and is influenced by sex hormones. Our aim was to investigate changes in visceral fat and the ratio of visceral fat to total body fat (VAT/TBF) and their associations with changes in lipids and insulin resistance after 1 year of hormone therapy in trans persons. Methods In 179 trans women and 162 trans men, changes in total body and visceral fat estimated with dual-energy X-ray absorptiometry before and after 1 year of hormone therapy were related to lipids and insulin resistance [homeostatic model assessment of insulin resistance (HOMA-IR)] with linear regression analysis. Results In trans women, total body fat increased by 4.0 kg (95% CI 3.4, 4.7), while the amount of visceral fat did not change (−2 grams; 95% CI −15, 11), albeit with a large range from −318 to 281, resulting in a decrease in the VAT/TBF ratio of 17% (95% CI 15, 19). In trans men, total body fat decreased with 2.8 kg (95% CI 2.2, 3.5), while the amount of visceral fat did not change (3 g; 95% CI −10, 16; range −372, 311), increasing the VAT/TBF ratio by 14% (95% CI 10, 17). In both groups, VAT/TBF was not associated with changes in blood lipids or HOMA-IR. Conclusions Hormone therapy in trans women and trans men resulted in changes in VAT/TBF, mainly due to changes in total body fat and were unrelated to changes in cardiometabolic risk factors, which suggests that any unfavorable cardiometabolic effects of hormone therapy are not mediated by changes in visceral fat or VAT/TBF.

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Gender dysphoria and sexual euphoria - A Bayesian perspective on the influence of gender-affirming hormone therapy on sexual arousal

10.1101/2021.11.22.21266679 ◽

2021 ◽

Author(s):

Manfred Klöbl ◽

Murray Bruce Reed ◽

Patricia Handschuh ◽

Ulrike Kaufmann ◽

Melisande Elisabeth Konadu ◽

...

Keyword(s):

Sexual Orientation ◽

Hormone Therapy ◽

Sexual Arousal ◽

Response Patterns ◽

Erotic Stimuli ◽

Trans Men ◽

Subjective Sexual Arousal ◽

In Trans ◽

Trans Women ◽

In Cis

While the concept of sexual orientation is more clearly defined in cisgender, this is less so in transgender individuals. Both experienced gender and sex hormones have a relation to sexual preferences, arousal in response to erotic stimuli, and thus sexual orientation. In transgender individuals sexual orientation occasionally changes before or during transition, which may involve gender-affirming hormone therapy. Using functional magnetic resonance imaging, we investigated whether the neuronal and behavioral patterns of sexual arousal in transgender individuals moved from the given (before) to their chosen gender after 4.5 months of hormone therapy. To this aim, trans women and men as well as age-matched cisgender controls rated visual stimuli showing heterosexual, lesbian or gay intercourse for subjective sexual arousal. Utilizing a Bayesian framework allowed us to incorporate behavioral findings in cisgender individuals of different sexual orientations. The hypothesized changes in response patterns could indeed be observed in the behavioral responses to the single but not the differentiation between stimulus categories with the strongest results for trans men and lesbian scenes. Activation of the ventral striatum supported our hypothesis only for lesbian scenes in trans women. This prominent role of lesbian stimuli might be explained by their differential responses in cis women and men. We show that correlates of sexual arousal in transgender individuals might change in direction of the chosen gender. Future investigations longer into transition might resolve the discrepancy on behavioral and neuronal levels.

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Physical and Sociodemographic Features Associated With Quality of Life Among Transgender Women and Men Using Gender-Affirming Hormone Therapy

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.621075 ◽

2021 ◽

Vol 12 ◽

Author(s):

Eliane D. Silva ◽

Tayane M. Fighera ◽

Roberta M. Allgayer ◽

Maria Inês R. Lobato ◽

Poli Mara Spritzer

Keyword(s):

Quality Of Life ◽

Hormone Therapy ◽

Gender Dysphoria ◽

Transgender Women ◽

Breast Development ◽

Body Hair ◽

Trans Men ◽

In Trans ◽

Trans Women

Background: Gender dysphoria is defined as a feeling of distress resulting from the incongruence between the sex assigned at birth and the gender identity, lasting longer than 6 months. In individuals with gender dysphoria, gender-affirming hormone therapy (GAHT) may improve quality of life (QoL).Objectives: We aimed to assess perceived QoL, to compare QoL scores between trans women and men and to identify possible contributing factors related to GAHT in a sample of transgender women and transgender men.Methods: In this cross-sectional study, transgender women and men were recruited by availability sampling from a national transgender health service. Individuals over 18 years old with a confirmed diagnosis of gender dysphoria receiving medically prescribed GAHT for at least 6 months were consecutively included. Also included were trans men who had undergone mastectomy and trans women who had received breast augmentation surgery. Individuals who had undergone gender affirmation surgery (specifically genital surgery) or with uncontrolled clinical/psychiatric conditions at the time of the initial assessment were excluded. Sociodemographic, physical, and hormone data were collected from all participants. The WHOQOL-BREF questionnaire was used to evaluate QoL. A total of 135 transgender individuals were invited. Seventeen individuals with previous genital surgery (12.6%) and five who refused to participate (3.7%) were excluded. Therefore, 113 patients were enrolled and completed the study (60 trans women and 53 trans men).Results: QoL scores did not differ between trans women and trans men. In trans women, greater breast development and stable relationships, and higher body mass index were associated with higher QoL domain scores. In trans men, higher domain scores were found in individuals in a stable relationship, with increased body hair, engaging in physical activity, and being employed.Conclusion: Data from this study suggest that GAHT-related physical characteristics, such as breast development in trans women and increased body hair in trans men, are similar between groups, are associated with higher QoL scores, and that sociodemographic parameters may impact these associations. Healthcare providers might consider these factors when planning interventions to improve QoL in transgender individuals.

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Association of hepatitis C with insulin resistance and type 2 diabetes in US general population: the impact of the epidemic of obesity

Journal of Viral Hepatitis ◽

10.1111/j.1365-2893.2011.01554.x ◽

2011 ◽

Vol 19 (5) ◽

pp. 341-345 ◽

Cited By ~ 35

Author(s):

M. Stepanova ◽

B. Lam ◽

Y. Younossi ◽

M. K Srishord ◽

Z. M. Younossi

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Hepatitis C ◽

General Population ◽

The Impact

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Insulin resistance in transgender individuals correlates with android fat mass

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018820985681 ◽

2021 ◽

Vol 12 ◽

pp. 204201882098568

Author(s):

Ingrid Bretherton ◽

Cassandra Spanos ◽

Shalem Y. Leemaqz ◽

Gehan Premaratne ◽

Mathis Grossmann ◽

...

Keyword(s):

Insulin Resistance ◽

Body Composition ◽

Fat Mass ◽

Lean Mass ◽

Fat Distribution ◽

Trans Men ◽

Increased Risk ◽

Android Fat ◽

In Trans ◽

Trans Women

Background: Transgender individuals receiving gender-affirming hormone therapy (GAHT) are at increased risk of adverse cardiovascular outcomes. This may be related to effects on body composition and insulin resistance. Aims: To examine relationships between body fat distribution and insulin resistance in transgender individuals on established GAHT. Methods: Comparisons of body composition (dual energy X-ray absorptiometry) and insulin resistance [Homeostasis Model of Insulin Resistance (HOMA2-IR)] were made between transgender individuals (43 trans men and 41 trans women) on established GAHT (>12 months) and age-matched cisgender controls (30 males and 48 females). Multiple linear regressions were used to examine the relationship between HOMA2-IR and fat mass with gender, adjusting for age and total duration of GAHT and Pearson correlation coefficients are reported. Results: Compared with control cisgender women, trans men had mean difference of +7.8 kg (4.0, 11.5), p < 0.001 in lean mass and higher android:gynoid fat ratio [0.2 (0.1, 0.3), p < 0.001], but no difference in overall fat mass or insulin resistance. Compared with control cisgender men, trans women had median difference in lean mass of −6.9 kg (–10.6, –3.1), p < 0.001, fat mass of +9.8 kg (3.9, 14.5), p = 0.001, lower android:gynoid fat ratio −0.1 (–0.2,–0.0), p < 0.05), and higher insulin resistance 1.6 (1.3–1.9), p < 0.001). Higher HOMA2-IR correlated with higher android ( r2 = 0.712, p < 0.001) and gynoid ( r2 = 0.572, p < 0.001) fat mass in both trans men and trans women. Conclusion: Android fat more strongly correlates with insulin resistance than gynoid fat in transgender individuals. Higher fat mass and insulin resistance in trans women may predispose to increased cardiovascular risk. Despite adverse fat distribution, insulin resistance was not higher in trans men.

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Physical and Sociodemographic Features Associated With Quality of Life in Transgender Individuals Using Gender-Affirming Hormone Therapy

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1616 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A794-A795

Author(s):

Eliane Dias Da Silva ◽

Tayane Muniz Fighera ◽

Roberta Martins Costa Moreira Allgayer ◽

Maria Inês Rodrigues Lobato ◽

Poli Mara Spritzer

Keyword(s):

Quality Of Life ◽

Hormone Therapy ◽

Gender Dysphoria ◽

Transgender Women ◽

Genital Surgery ◽

Trans Men ◽

Significant Difference ◽

In Trans ◽

Trans Women

Abstract Background: Gender dysphoria is defined as a feeling of distress resulting from the incongruence between the gender assigned at birth and the identity gender and lasting longer than 6 months. In individuals with gender dysphoria, gender-affirming hormone therapy(GAHT) may improve quality of life (QoL). Objectives: Here, we aimed to assess perceived QoL and possible contributing factors in a sample of transgender women and transgender men using GAHT. Methods: In this cross-sectional study, transgender women and men were recruited by availability sampling from a national transgender health service. Individuals over 18 years old with a confirmed diagnosis of gender dysphoria receiving medically prescribed GAHT for at least 6 months were consecutively included. Also included were trans men who had undergone mastectomy and trans women who had received breast augmentation surgery. Individuals who had undergone gender affirmation surgery (specifically genital surgery) or with uncontrolled clinical/psychiatric conditions at the time of the initial assessment were excluded. Sociodemographic, physical, and hormone data were collected from all participants. The WHOQOL-BREF questionnaire was used to evaluate QoL. A total of 135 transgender individuals were invited. Seventeen individuals with previous genital surgery (12.6%) and five who refused to participate (3.7%) were excluded. Therefore, 113 patients were enrolled in the study (60 trans women and 53 trans men). Results: There was no significant difference in QoLbetween the groups. In trans women, greater breast development and stable relationships, and higher body mass index were associated with higher QoLdomain scores. In trans men, higher domain scores were found in individuals with a stable relationship, increased body hair, physical activity practice, and being employed. Conclusion: Data from this study suggest that GAHT-related physical characteristics are associated with higher QoLscores, and that sociodemographic parameters may impact these associations. Healthcare providers might consider these factors when planning interventions to improve QoLin transgender individuals.

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