The prevalence of type 1 diabetes in transgender and gender-specific patients is higher than in the general population.
This was reported by three groups. In two studies, the cohort included children; in the other older adults.
One article documents an almost five-fold higher rate of type 1 diabetes among adolescents who participated in a city gender program. The study by Johsias Maru of the Department of Endocrinology at Boston Children’s Hospital in Boston, Massachusetts and colleagues was published online February 15 in Transgender Health.
In the two studies on youth cohorts, there was evidence that glycemic control improved at least temporarily after the start of gender-specific care.
“The psychological benefits of gender-affirming treatment are known and persistent. Just listening to and affirming these children and using their real names and pronouns is enormous, and it has incredible benefits … When you are at it In better mental condition you can better manage your diabetes, “said endocrinologist Kate Millington, MD, second author of the Boston Children’s Hospital study, in an interview with Medscape Medical News.
The second children’s study, conducted in Wisconsin and published in Pediatric Diabetes in November 2019, also reported an increase in the prevalence of type 1 diabetes in patients diagnosed with gender dysphoria.
The first report on this association was published in Sexual Medicine in 2017. Justine Defreyne, MD, and colleagues from Ghent University Hospital, Ghent, Belgium, documented a 2.3-fold higher prevalence of type 1 diabetes mellitus in adult transgender patients than in the general Belgian population.
Theories include “minority stress” and closeness to care
There are several hypotheses about the connection, says Millington.
One of these is “minority stress,” where chronic pressures to feel different from their peers can act as a trigger for those genetically predisposed to type 1 diabetes or other autoimmune diseases.
“We know that children who are sexual and gender-specific minorities live with a lot of stress only because of their existence, which is independent of when they come to their families. They could live for years with this knowledge of feeling different and not really knowing how to do it. Explain. And that can take a toll on the body that we can’t really measure, “explains Millington.
Since the majority of participants in the three cohorts were diagnosed with type 1 diabetes prior to gender-based treatment, another possibility is that these patients may have more interactions with the health system, particularly with endocrinologists.
At Boston Children’s, the diabetes clinics and gender programs are in the same facility.
“These are children who have access to medical care … Many children’s clinics in large facilities that care for children with diabetes are also linked to the trans clinic, so the waiting rooms may have the trans flag or the rainbow flag or other type of acceptance indicator “admits Millington.
The situation with the adult group in Belgium was different. There, patients received diabetes care from local diabetologists, not at the transgender referral center at Ghent University Hospital.
“However, the fact that a transpersonal person is being examined by a peripheral endocrinologist for follow-up care for type 1 diabetes mellitus may increase the likelihood that that person will be referred to an endocrinologist who specializes in transgender care,” Defreyne and colleagues wrote in Year 2017.
Five to ten times higher prevalence of gender-specific dysphoria in children with T1D
Of 1,114 patients treated at Boston Children’s Hospital’s Gender Multispecialty Service during 2007-2018, 10 had previously been diagnosed with Type 1 diabetes and another patient was gendered within two weeks of their first visit -Clinic made a diagnosis. The prevalence rate of type 1 diabetes was 9.87 per 1000, which is 5.11 times the expected rate of 1.93 per 1000 in the general population.
The Wisconsin team, led by Dr. Santhi N. Logel, of the Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, extracted electronic data for the period November 2007 through November 2017. Among adolescents and adolescents In young adults ages 10 to 21 Years ago, 315 was diagnosed with gender-specific dysphoria and in 2017 with type 1 diabetes. The prevalence rates were 0.42 and 2.69 per 1000, respectively.
Eight patients were diagnosed with both diseases. The prevalence of type 1 diabetes in people with gender dysphoria was 24.77 per 1,000, 9.4 times higher than the prevalence of type 1 diabetes alone.
The Belgian cohort included 1,081 adult transgender patients, 10 of whom had previously been diagnosed with type 1 diabetes or latent autoimmune diabetes in adulthood. The rate was about 2.3 times higher than expected.
Differences according to age, type of gender-specific discordance between the groups
In the Boston group, the mean age at diagnosis of type 1 diabetes was 8.5 years, significantly younger than the mean of 14.5 years in the general US population with type 1 diabetes.
In contrast, the average age when people with type 1 diabetes first visited the gender service was 16 compared to 13 years older than that of people without diabetes.
At the Wisconsin clinic, the median age at which patients were diagnosed with type 1 diabetes was 9.9 years and the median age at which they first visited a gender clinic was 13 years. “Logel and colleagues notice.
The mean age of the Belgian adult group was 36.7 years; The ages ranged from 19 to 53 years and the mean age at the time of diagnosis of type 1 diabetes was 15.7 years. Five patients remembered their age at the time they first experienced a sense of incongruity between the sexes. The mean age at which they had these feelings was 6.8 years (range, 4–13 years).
Millington notes that a younger age at the time of type 1 diabetes diagnosis would be consistent with the causative hypothesis. “We found that the children in our cohort got their diabetes earlier than expected,” she said.
She admits that it is difficult to determine when feelings of gender discordance begin.
“Children just don’t have great memories. Plus, for a lot of these children, it’s been just their identity all their lives. We’re always trying to get that variable, and it’s very, very difficult to get a reliable estimate,” she said .
The ratio of people who were assigned male to female gender at birth before the transition was different in the three cohorts.
In Boston, the majority of patients – 9 out of 11 – were classified as female at birth and had a transmasculine identity. The Wisconsin group was mixed – three as transfeminals, three as transmasculins, one as “Gender Fluid” and one as “Gender Neutral”.
In Belgium, among adults, 8 out of 10 men were women.
These differences reflect a general shift in the gender world, says Millington.
“Traditionally they were transfeminine, born with male anatomy who identify as female … Well, that changes dramatically. We see far more transmasculine individuals, female at birth with male gender identities. We see that 2 to 1. It is really dramatic. A lot of clinics have reported this. “
Millington said, while there are many theories as to why, “It’s probably just about what society will accept rather than something in the water.”
Does Treatment for Gender Dysphoria Affect Diabetes Control?
In Boston, nine of the people received sex-affirming hormones (eight received testosterone, one received estrogen). Two also received pubertal oppression. The mean A1c value decreased from 8.46% at the first clinic visit to 8.16% 6 months later.
In Wisconsin, four teenagers received therapy to block puberty and two received estrogen and testosterone for sex-affirming therapy. Although blood sugar control initially improved after the first visit to a gender clinic, there were no improvements in A1c levels after the hormonal treatments.
Millington notes that both puberty and sex steroids could increase insulin resistance and therefore worsen blood sugar control, but “I think the psychological benefits outweigh that.”
When asked how she might counter arguments against such treatment for young patients, she noted, “You need to think about whether you are doing what is best for the child or for yourself.
“Often we have our own fears and prejudices, and sometimes we leave blind what is actually best for the child in front of us … I think all you need is meet and hear a transgender person their story. It’s really transformative. “
The authors have not disclosed any relevant financial relationships.
Transgend health. Published online February 15, 2021. Executive summary
Pediatric Diabetes. Published online November 20, 2019. Summary
Sex Med. Published online on August 1, 2017. Full text
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