Association between gender affirming hormone therapy and measures of glucose metabolism: A longitudinal study Open Access

Anike, Olivia (Spring 2023)

Permanent URL:


Background: The effect of gender affirming hormone therapy (GAHT) on glucose metabolism and insulin resistance is an area of priority in transgender health research.

Aim: To analyze longitudinal changes in fasting glucose (FG) and hemoglobin A1c (HbA1c) levels in transfeminine (TF) and transmasculine (TM) persons following GAHT initiation in comparison to corresponding changes in cisgender reference groups.

Methods: The data for this study were collected from electronic health records of individuals enrolled in the Study of Transition and Gender (STRONG) cohort nested within 3 large integrated healthcare systems. The analysis dataset i included 2,735 TF persons compared to 21,447 cis-male (CM) and 23,632 cis-female (CF) referents as well as 2,276 TM participants compared to 14,741 CM and 16,935 CF referents. The follow up time was divided into two intervals: between first blood test (FG or HbA1c) and the day before GAHT initiation, and between GAHT initiation date and the date of the most recent blood test. Linear mixed models were used examine changes in log-transformed FG and HbA1c levels among TF and TM cohorts following GAHT initiation in comparison to cisgender referents. These changes were expressed as relative differences (%) and ratios-of-ratios along with 95% confidence intervals (CI).

Results: Among TF participants, post-GAHT ratios-of-ratios for FG were 7.9 (95% CI: 1.3, 14.6) and 8.1 (95% CI: 2.4, 13.9) depending on the model. The results were in the same direction but not significant for HbA1c. Among TM participants, the model-specific post-GAHT ratios-of-ratios for HbA1c were 8.7 (95% CI: -2.5, 19.9) and 10.0 (95% CI: 0.4, 19.7), while the corresponding results for FG were weaker and not statistically significant. None of the ratio-of-ratios comparing post-GAHT changes among transgender and cisgender study participants were significant. Other factors consistently associated with significantly higher measures of glucose metabolism were advanced age and being obese/overweight.

Conclusion: Though the within-transgender cohort data suggest a slight increase in the levels of FG and HbA1c following GAHT initiation, these changes were not significant when compared to the corresponding changes in cisgender referents. Based on these results it appears unlikely that GAHT has a clinically important effect on glucose metabolism. 

Table of Contents

Introduction 1

Methods 4

Results 8

Discussion 11

Conclusion 15

References 16

Tables 20

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
Subfield / Discipline
  • English
Research Field
Committee Chair / Thesis Advisor
Last modified

Primary PDF

Supplemental Files