Gender-Affirming Type 2 Diabetes Healthcare

Editor's note: The term "transgender" in this article includes transgender women, transgender men, and the diverse community of nonbinary and genderqueer people. You can find more terms related to this topic in the glossary at the end of the article.

If you are a transgender person with type 2 diabetes, working with a healthcare team that understands your needs is vital. But transgender people face many barriers to receiving respectful and gender-affirming healthcare.^1-4

Gender identity: basics

Gender identity refers to a person's internal sense of their own gender. The term "transgender" generally describes people whose gender identity differs from the sex they were assigned at birth.^5-7

A transgender man is someone whose birth-assigned sex was female but whose gender identity is male. A transgender woman is someone whose birth-assigned sex was male but whose gender identity is female. Nonbinary or genderqueer refers to people whose gender identity is not limited to the traditional binary of men and women.^5-7

The terms used to describe the diverse experiences of transgender people can be unfamiliar to some people. But communicating with respect honors each person's identity, regardless of their gender.

Transgender people and barriers to health

Discrimination and stigma harm the mental and physical well-being of transgender people. About 1 in 3 transgender people report at least 1 negative experience with healthcare providers related to their gender. And nearly 1 in 4 avoid seeing a doctor because of fear of discrimination.^3,8

Prejudice in day-to-day life also interferes with transgender people's health. Compared to cisgender people, transgender people face higher rates of:^3,8

• Discrimination
• Unemployment
• Poverty
• Homelessness
• Violence

Transgender people are also at higher risk of:^1,8

• Substance use disorders
• Tobacco use
• Anxiety
• Depression and suicide

Diabetes risk in transgender people

Experts are divided about the risk of diabetes in transgender people. A 2022 study found that transgender women had a higher risk of type 2 diabetes than cisgender women. However, there was no difference in the risk between transgender women and cisgender men. Transgender men did not have an increased risk of type 2 diabetes.^9,10

Other studies have found no overall increased risk of type 2 diabetes in transgender people.^9,10

Gender-affirming hormone therapy and diabetes risk

Some transgender people use a treatment called gender-affirming hormone therapy (GAHT). GAHT helps transgender people align their physical appearance with their gender identity. It is unclear what role GAHT has on the overall risk of diabetes.^2,10-12

Hormones used by transgender women can cause weight gain and change how the body reacts to insulin. This may increase the risk of diabetes. However, not all experts agree on this. Estrogen therapy in transgender women also increases the risk of heart disease, especially among people who smoke.^2,10-13

Transgender men may take testosterone to help their body align with their gender identity. This hormone does not seem to increase the risk of diabetes. But it can increase the risk of low glucose levels in transgender men with type 2 diabetes. Insulin and other diabetes medicines may need to be adjusted after starting testosterone.^1,2,10,11

Gender-affirming hormone therapy and diabetes screening

Experts recommend diabetes screening before starting GAHT. For transgender people on GAHT, annual diabetes screening is recommended. People with a family history of diabetes or excess weight gain may need more frequent screening.¹³

Diabetes management in transgender people

Treatment of type 2 diabetes in transgender people is the same as for other people. The foundation of diabetes management in all people includes:^2,13

• Blood glucose monitoring
• Exercise
• Nutrition
• Weight management
• Glucose-lowering medicines
• Insulin

Transgender people with type 2 diabetes are at an increased risk of mental and emotional problems. It is crucial to address mental, emotional, and social challenges related to:^1,3,8

• Poverty
• Depression and anxiety
• Discrimination
• Violence
• Chronic stress from harassment and transphobia
• Substance use disorders

Resources for finding supportive healthcare

Access to gender-affirming healthcare that is free from stigma and bias is essential for transgender people with type 2 diabetes.

Here are some resources to help you connect with a safe and supportive healthcare team:^14-17

• World Professional Association for Transgender Health (WPATH)
• University of California San Francisco (UCSF) Transgender Care
• National Center for Transgender Equality
• LGBTQ+ Healthcare Directory

Glossary of helpful terms

These terms can help you better understand and support the spectrum of gender identity:⁶

• Cisgender – Refers to a person whose gender identity is aligned with their sex assigned at birth.
• Gender-affirming hormone therapy (GAHT) – Medicine used to align hormone balance and physical appearance with gender identity.
• Gender – Socially created norms about the characteristics and roles of women and men.
• Gender-diverse – Describes the community of people who fall outside of societal gender expectations of man or woman.
• Gender expression – The way a person communicates their gender to the world.
• Gender identity – A person's inner sense of their own gender.
• Nonbinary (also genderqueer or gender queer) – Refers to a person whose gender identity falls outside the traditional gender expectations of man or woman.
• Queer – Refers to people who think of their sexual orientation or gender identity as outside of societal norms.
• Sex assigned at birth – The biological sex (male or female) assigned to an infant based on their anatomy.
• Transgender – Describes a person whose gender identity is not aligned with their sex assigned at birth.
• Transgender man – Refers to a person whose gender identity is boy/man (but was assigned female sex at birth).
• Transgender woman – Refers to a person whose gender identity is girl/woman (but was assigned male sex at birth).
• Transphobia – Discrimination, fear, and hatred of transgender people.