Gender Affirming Hormone Therapy and Diabetes

Eating a healthy diet is the cornerstone of living well with diabetes and preventing complications. Unfortunately, transgender individuals on gender-affirming hormone therapy (GAHT) are at increased risk of diabetes. And those already diagnosed with the disease may have to intensify their diabetes management. 

Transgender individuals have a gender identity that is different from their sex assigned at birth. According to the UCLA Williams Institute,  Blacks are more likely than whites to identify as transgender.

Recent estimates from state and federal data suggest that around 0.6% of the adult population in the USA (1.4 million adults) identify as transgender.

Moreover, close to half (40%) of the adult population of the USA is expected to develop type 2 diabetes at some point during their lifetime, and about 1.25 million Americans are currently living with type 1 diabetes.

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Transgender Women (Male to Female) will typically receive estrogen and androgen blockers to make their bodies feminine. Androgens are a group of hormones that play a role in male traits. The primary androgens are testosterone and androstenedione.

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There is a strong association between low testosterone and diabetes. Men with diabetes tend to have low testosterone, and men with low testosterone can develop diabetes later in life.

In addition, estrogen may elevate triglycerides and increase the risk for hypertension and type 2 diabetes, particularly among individuals with a family history of diabetes or other risk factors for diabetes. 

Transgender Men (Female to Male) are typically given testosterone to make their bodies more masculine. Testosterone suppresses the menstrual cycles and decreases the production of estrogen from the ovaries. Testosterone is associated with heart disease, high blood pressure, and type 2 diabetes in transgender men. Those with significant weight gain, a family history of diabetes, or polycystic ovarian syndrome are at increased risk.

In a recent study of transgender individuals with type 1 diabetes or type 2 diabetes, researchers found that those with diabetes on hormones for gender confirmation had increased risks associated with diabetes.

Triglycerides tended to be high in transgender women, most likely due to diabetes and the use of estrogens.

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In addition, LDL ‘bad’ cholesterol was higher, and HDL or ‘good’ cholesterol was lower in obese patients with type 2 diabetes.

They also found that individuals with diabetes had low vitamin D levels, which is needed to prevent osteoporosis.

Transgender women with T2D also tend to be obese, requiring intensive weight loss management. 

The following guidelines can help to reduce the diet-related risk factors associated with diabetes and GAHT:

• Limit saturated fat to less than 10% of calories per day. That’s 22 grams of saturated fat per day for a 2,000-calorie diet.
• Limit sodium intake to less than 2,300mg per day—the equivalent of one teaspoon of table salt.
• Limit added sugars to less than 10% of calories per day. That’s 200 calories, or about 12 teaspoons, for a 2,000-calorie diet.
• Limit alcoholic beverages (if consumed) to 2 drinks or less a day for men (male-bodied) and one drink or less a day for women (female-bodied). One drink equals:12 ounces of regular beer; 8 ounces of malt liquor; 5 ounces of red or white wine; 1.5 ounces or a “shot” of 80-proof distilled spirits or liquor.
• Increase fiber to a minimum of 14 grams per 1,000 calories – or about 28 grams per day for female-bodied and 34 grams of fiber per day for male-bodied.

Are you looking for more information on healthy eating to prevent or manage diabetes while on GAHT? 

A registered dietitian nutritionist (RDN) can help. To find an RDN near you, use the Academy of Nutrition and Dietetics online Find an Expert service.