Gender-affirming Hormone Therapy and Risk of Diabetes in Transgender Persons Comment

• Authors: Vin Tangpricha, Emory University
• Journal Title: JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
• Volume: Volume 107, Number 6
• Publisher: ENDOCRINE SOC | 2022-02-01, Pages E2632-E2633
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1210/clinem/dgac060
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Endocrinology & Metabolism; transgender; diabetes; estradiol; testosterone; cardiovascular

Abstract

Most transgender people request gender-affirming hormone therapy (GAHT) to affirm their gender identity and to improve quality of life and well-being (1). GAHT has been regarded as safe when following guidelines to ensure that sex hormone concentrations do not exceed values found in men and women (1). However, recent large cohort studies have raised concerns about the long-term risk of cardiovascular disease after receipt of GAHT (2, 3). Transgender women followed at the Amsterdam Cohort of Gender Dysphoria experienced higher than expected cardiovascular deaths compared to the general Dutch population (2). In the US-based STRONG cohort, transgender women had increased rates of stroke compared with cisgender men and women (3). The reasons for the increased rates of major cardiovascular events (MACEs) found in transgender women are unclear. Increased risk of diabetes may contribute to the increased risk of MACEs associated with GAHT. Early studies have suggested that GAHT worsens insulin resistance and risk of diabetes in transgender women (4). In addition, GAHT in transgender women has been associated with increased body mass index, which may further increase the risk of diabetes (5).