Many Years Ago, The Doctor Said…

...That one of the negative side effects of Cross-Gender Hormone Therapy was diabetes, that was back in 2004

Diabetes is in my family medical history so it was no surprise that back in 2012 I developed diabetes.

Navigating the LGBTQ Life with Diabetes
Healthline
By Mike Hoskins
June 26, 2019


When Beckett Nelson began transitioning from female to male, he had already been living with type 1 diabetes for over a quarter-century. But as that transition ramped up from a social circle name change into a medical transformation and hormone therapy, Nelson was pretty concerned about the combo of LGBTQ life and diabetes.

“There were times with the diabetes that I wasn't sure what to expect and didn't know anybody in the same boat,” says this 38-year-old nurse in Toronto, Canada. “I know everybody is different, but it would have been helpful to know what I was up for."
[…]
Just prior to transitioning, Nelson said his endo went over the usual side effects of testosterone: lower voice, hair growth, acne, etc. But there was no mention of diabetes or how it might impact that side of his health, such as blood sugars. He says little medical info exists on that dual topic, but he found help from the DOC -- even D-parents sharing that their teenage sons were a bit more sensitive to insulin, which was informative.

As I mentioned, the doctor warned me about my risks and I accepted them and I hope other doctors have warned their patients about the risk of  Cross-Gender Hormone Therapy including heart disease, Deep Vein Thrombosis, and other dangerous side effects.

UCSF Center of Excellence for Transgender Health says this about diabetes,

The effect of gender affirming hormone therapy on diabetes risk or disease course is unclear. A Dutch case-control study noted an increased prevalence of type 2 diabetes mellitus among transgender men and women in comparison to both age matched non-transgender male and female groups, however the study did not adjust for other risk factors. A study of the effects of gender affirming hormones on insulin resistance in transgender women and men found that transgender women may experience some increase in markers of insulin resistance, while transgender men exhibited no change. Some data from non-transgender men suggests that testosterone lowers insulin resistance. Data are mixed on the presence of increased rates of polycystic ovarian syndrome (PCOS) in transgender men prior to hormone therapy. While non-transgender female patients with PCOS require close monitoring for development of diabetes due to marked insulin resistance, it is unclear if this risk remains once the hormonal milieu has been modified with the addition of testosterone. While insulin resistance serves as a useful surrogate marker to inform risk, outcome studies using a diagnosis of diabetes as the end point have not been conducted.

Let’s face it we are guinea pigs, there is no long term health risks studies on us, everything is just an extrapolation of women’s health.

In a paper in Diabetes Spectrum there is this section…

Prevalence Assumptions
Identifying diabetes prevalence within the LGBT community is no easy task. Data collection methods used to distinguish this subgroup within the U.S. population are not systematic, LGBT status is often
underreported and prone to measurement error, and scientific evidence is also blocked.

The Department of Health and Human Services refused to publish a 488-page Healthy People 2010 companion document for LGBT health, thereby eliminating the incorporation of sexual minority issues into the nation’s health care agenda. The intentional omission of LGBT health data into mainstream science is reminiscent of homophobic tactics that have been used in the past and may have resulted from a climate that continues today.
[…]
How many LGB people have diabetes? (Transgender individuals are omitted from this discussion because of limited data.)…

Data is not being collected on us. I was in a meeting with researcher and LGBT+ community members;  we asked for them to include two questions, sexual orientation and gender identity for the research, the researchers hemmed and hawed and came up with the thousand different reasons why they couldn’t include us in their demographic data. It boiled down to it wasn’t done before and we don't want to do it now.

The little research that exists about diabetes outcomes and LGBTQ specifically paints a bleak picture. A Northwestern Medicine study from 2018 is one of the first of its kind to examine how health behaviors are linked to "minority stress" – issues of being stigmatized and marginalized – and how this may contribute to the risk of poor health among LGBTQ youth. That includes worse mental and physical health outcomes, the study authors found, and Garnero notes that it can certainly applies to those with T1D, especially if their healthcare professionals aren’t interacting with them effectively.

Just remember one thing… having diabetes does not prevent you from transitioning. It just means you have to more vigilant about side effects.

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I have a 2 hour video conference this morning about how family leave bills affect LGBTQ+ families… so much fun.