Diabetes is common. Over 7% of people in the U.S. have diabetes -- though nearly a quarter of them are unaware that they have the disease.

Diabetes is serious. Over time, high levels of blood sugar severely damage various organs, including the heart, blood vessels, kidneys, eyes, and nerves.

Diabetes can be prevented or managed. People with diabetes can live long, healthy, happy lives. Please consult your doctor.

Diabetes is a transgender concern.  While more research is needed, there are risk-factors related  to hormone-use, as well as in transmen who do not take testosterone.

In addition to more specific risk factors, many transgender people have complicated relationships with our bodies, which may lead to our being overweight and/or physically inactive. These factors may lead to increased risk of diabetes.

• What is diabetes?
• Are transgender people at increased risk of getting diabetes?
• What are symptoms of diabetes?
• What are other risk-factors for developing diabetes?
• What if I have diabetes?

Diabetes is a disorder that causes high blood sugar due to problems with the hormone insulin.

• Type 1 diabetes (10% of cases) occurs when the pancreas no longer produces insulin.
• Type 2 diabetes (90% of cases) occurs when the pancreas doesn’t produce enough insulin or the body doesn’t effectively use the insulin that is produced (insulin resistance).

Over time, high levels of blood sugar severely damage various organs, including the heart, blood vessels, kidneys, eyes, and nerves.

Pre-diabetes (a.k.a. Impaired Glucose Tolerance (IGT), Impaired Fasting Glucose, or “borderline diabetes”) refers to a condition where your blood sugar is higher than normal, but not so high that you have diabetes. People with pre-diabetes are at increased risk for cardiovascular disease, and also for being diagnosed with diabetes.

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As with so many health conditions, the research is inadequate and inconclusive. However, we do know about some risk factors particular to transgender experience.

• Estrogen is known to affect glucose tolerance and may increase transwomen's risk of diabetes.
• There is no evidence that testosterone increases transmen's risk of Type 2 diabetes. However, studies of transmen found increased fat deposits around the abdomen and the internal organs after starting testosterone, and this is considered a risk factor for insulin resistance.
• Several studies of transmen who had not yet started testosterone showed increased rates of polycystic ovarian syndrome (PCOS) compared to other people born with ovaries. PCOS is associated with increased rate of pre-diabetes.

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People with pre-diabetes don't often have symptoms. In fact, millions of people have diabetes and don't know it because symptoms develop so gradually, people often don't recognize them. Some people have no symptoms at all. Others may experience unusual thirst, a frequent desire to urinate, blurred vision, or a feeling of being tired most of the time for no apparent reason.

For many, diagnosis may come seven to ten years after the onset of the disease. Therefore, early diagnosis is critical to successful treatment and delaying or preventing some of its complications such as heart disease, blindness, kidney disease, stroke, amputation and death.

• All people over age 40 should be screened for diabetes every 3 years, with screening every year for people who have other risk factors.
• Because estrogen is known to affect glucose tolerance, transwomen who gain more than 5 kg after starting estrogen should have their blood sugar levels checked.
• For transmen, yearly testing is recommended if you had signs and symptoms of PCOS before starting testosterone.

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For many, diagnosis may come seven to ten years after the onset of the disease. Therefore, early diagnosis is critical to successful treatment and delaying or preventing some of its complications such as heart disease, blindness, kidney disease, stroke, amputation and death.

Your risk of developing diabetes is higher if...

• You are age 40 or older
• You are a member of a high-risk ethnic group (Aboriginal, African, Asian/South Asian, Hispanic)
• You are overweight –- especially if you carry most of your weight around your middle
• You have metabolic syndrome (3 or more of high blood pressure, low HDL cholesterol levels, high triglyceride levels, high blood sugar, high amount of fat around your waist)
• You have polycystic ovarian syndrome (PCOS)
• You have a family history of diabetes
• You are physically inactive as a habit

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Type 1 diabetes is treated with insulin injections, a balanced diet plan, and careful health monitoring.

For people with pre-diabetes or Type 2 diabetes, treatment usually focuses on lifestyle changes (increased exercise, changes in diet). If this does not bring your blood sugar under control, various medications may be prescribed to help your body make or use insulin more effectively. Insulin may also be used to treat Type 2 diabetes.

For transwomen who are diagnosed with Type 2 diabetes or glucose intolerance after starting estrogen, medication may be recommended to help sensitize your body to insulin (as estrogen can affect glucose metabolism). If this does not work, you may be switched to a different hormone combination or a different type of estrogen. If all else fails, your nurse or doctor may recommend that you decrease your estrogen dose to see if that helps stabilize your blood sugar.

For transmen, there is no evidence that taking testosterone contributes to diabetes or makes diabetes worse.  However, testosterone does tend to have an impact on cholesterol and can affect blood pressure. If you are not able  to bring such diabetic symptoms under control through diet, exercise, and/or medication, you may be switched to a different hormone combination or a different type of testosterone. If all else fails, your nurse or doctor may recommend that you decrease your testosterone dose to reduce your risk of heart disease.

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