XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

New Onset of Type 2 Diabetes Mellitus with Feminizing Hormone Therapy: Case Series

FELDMAN, JAMIE U.S.A.
E-mail: jfeldman@famprac.umn.edu

Background: Diabetes mellitus affects over 7% of the adult U.S. population, and the risk increases with age. The effects of hormone therapy on glucose tolerance in male to female transgender patients have not been specifically addressed in the medical literature. Male to female patients often present for feminizing therapy over the age of 40, and carry independent risk factors for diabetes. Feminizing hormone therapy itself can result in increased weight and body fat, contributing to glucose intolerance. This presentation will review three cases of new onset type 2 DM during the course of feminizing therapy.

Methods: From fall 1998 through 2001, 117 transgender patients have received ongoing medical care of the University of Minnesota’s Center for Sexual Health. All patients receive a full history and physical exam prior to the onset of hormone therapy. A routine set of laboratory tests, including casual and/or fasting glucoses, are checked every three to six months during the first year of treatment, then every six to twelve months thereafter. These labs are tracked across the course of treatment. Abnormal results are followed up either at CSH or in coordination with the patient’s primary care clinic. All medications, chronic medical conditions, and new diagnoses are tracked across the course of hormone treatment.

Results: Three male to female patients, ages 42-53, developed new onset diabetes mellitus type 2 during the course of feminizing therapy, as diagnosed by fasting glucoses greater than 126/mg/dl on at least two occasions (American Diabetes Association criteria). All patients were hormone-naive prior to treatment at CSH. All were Caucasian, overweight (BMI 31-37), but without family history of diabetes. All were noted to have hypercholesterolemia on their initial labs, and two had hypertension prior to hormone therapy. All regimens included spironolactone 100mg q day, while two of three regimens included a progestin (norethindrone 5mg). Two of the three were on oral estrogen at the time of diagnosis (estropipate 3.75mg q day and CEE 5mg q day), with hyperglycemia persisting after a change to transdermal estrogen (.1mg estradiol). The third patient was on transdermal estrogen throughout. All three patients were asymptomatic at the time of diagnosis.

Conclusion: Transgender patients, particularly those over age 40 with obesity, are at risk for diabetes. Feminizing therapy, either directly or indirectly through weight gain, may contribute to the onset of diabetes in this population. Further research is needed to evaluate the effects of feminizing regimens on glucose tolerance and to elucidate which patients may benefit by regular screening during the course of feminizing therapy.