Transgender women may be more likely to have type 2 diabetes than cisgender women

Transgender women may be at higher risk for type 2 diabetes compared to cisgender women, but not to cisgender men, according to new research published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Nearly 1 million people identify as transgender in the United States, and health care providers are encountering more transgender and gender-diverse patients in their practices. An important priority of transgender health research is to better understand the metabolic changes induced by gender-affirming hormone therapy, and a specific area of interest is the occurrence of type 2 diabetes.

"Our study findings provide some reassurance that gender-affirming therapy does not increase the risk of type 2 diabetes, but our analysis was not designed to evaluate more subtle subclinical changes," said Noreen Islam, M.D., M.P.H., of Emory University School of Medicine in Atlanta, Ga. "For this reason, health care providers should continue monitoring the metabolic status of individuals receiving gender-affirming therapy."

The researchers studied data from an electronic health record-based cohort study of people 18 years and older enrolled in three integrated health care systems over a 9-year period. The cohort included 2,869 transgender women matched to 28,300 cisgender women and 28,258 cisgender men; and 2,133 transgender men matched to 20,997 cisgender women and 20,964 cisgender men.

Type 2 diabetes was more common in transgender women compared to cisgender women. Cisgender is defined as a person whose gender identity is the same as their sex assigned at birth. The researchers found no significant differences in type 2 diabetes prevalence or incidence across the remaining comparison groups, both overall and in transgender people undergoing gender-affirming hormone therapy.

"Although more research is needed, there is little evidence that type 2 diabetes occurrence in either transgender women or transgender men is attributable to gender-affirming hormone therapy, at least in the short term," Islam said.