Living With Diabetes and Coming Out As Transgender

Claire Hinkle shares her experience coming out as transgender to her wife of 10 years, who also lives with diabetes. She describes the struggles and successes of living as a transgender woman with type 1 diabetes, and how to live an authentic life.

Editor's note: Some of the terms around this topic may be new or unfamiliar. Jump to the end of the article for a few helpful definitions.

December 30, 2021, is the day you could say I was reborn. I finally came out to my wife of 10 years that I was transgender. She, like me, has type 1 diabetes.

Funny enough, we actually met at a camp for diabetes called Camp Sweeney. It has to be some sort of divine intervention that I was able to meet someone who lived through the same struggles as me growing up with diabetes – and someone who chose to stay by me when I came out.

It was exceptionally hard since we’d known each other since age 12 and had been together for almost 13 years at this time. We’re still together today and have built a family with two precious daughters. Everything she knew about the male part of me was essentially fabricated. My greatest fear was that I would lose everything and everyone close to me if I came out. 

That’s also part of the reason why I suppressed my desire to transition for so many years. I knew that my personal relationships would not be the same, and some I previously called friends would not be there for me during my transition. 

Surprisingly enough, my loved ones have overall been very loving and supportive. I’ve even had people tell me they like the new “outgoing” me much better. I am genuinely happier and feel like my friends and family can see that, so it makes the change much easier. 

Challenges living as a transgender person with diabetes

Living as a transgender individual is not an easy task. It’s nothing that I would ever freely do unless the need was there. 

For three years I’d been in counseling trying to suppress lifelong feelings that – by December 30, 2021 – I could not any longer. I needed to finally take steps to begin hormone replacement therapy (HRT). The need was there, and if I didn’t do something, my life was going to take a bad turn. 

I am so grateful for the second chance at life I was given and the ability to live my life as authentically as I can while so many others cannot. I’m also thankful to have such a committed spouse, who also lives with diabetes. 

I’ve had type 1 diabetes for 24 years and have faced a fair number of challenges when it came to managing my disease. Unknown to me, I was going to be presented with challenges not soon after starting HRT as well. If you were (un)fortunate enough to live with diabetes before you hit puberty, then you should be all too aware of the toll that it takes on our glucose readings. 

For the first few months, while my hormones were shifting from male to female dominant, my diabetes was on a roller coaster with no reprieve. My insulin needs nearly doubled within the first eight months of being on HRT. 

Much like type 1 diabetes, transitioning is another lifelong commitment for me where I must constantly take my medications. I cannot and never will have the ability to produce my own estrogen that can sustain me. So, I have to supplement it with medications in order to be myself. 

Transitioning while managing diabetes 

Navigating through life with diabetes isn’t much different than navigating life while being transgender, actually. I still get the occasional stares when I get my insulin pump out to change my pod, people still ask me a million questions about it, and my lows are still as dramatic as they were before. 

This transition hasn’t been the easiest by far. Thankfully for me, I have an endocrinologist who was phenomenal in helping me regulate my diet and insulin to tackle these changes. In addition to suggestions from my providers, I am also now currently using a closed-loop automated insulin delivery (AID) system, which has been a lifesaver in my diabetes management. This was not an easy task, however. 

First, I had to keep my endocrinologist and primary care provider updated on how my glucose readings fluctuated throughout the months of my transition. As one healthcare expert provided me with life-saving treatment in order for me to become my true self, the other helped treat the symptoms associated with this new undertaking. Funny enough, endocrinologists also treat hormonal conditions and prescribe HRT; this new realm for me was not so new to them, which was comforting, to say the least. 

Second, I had to take all the education and guidance they were giving me and put it into practice. Getting my diabetes under control was challenging, but not impossible. My A1C went from 6.0% to 7.3%. I am on a closed-loop system that constantly monitors and regulates my basal settings, and am happy to say I’m now back at 6.2%. 

I credit my control through the chaos of my endocrine system changing genders to this excellent team of healthcare professionals as well as the technology of the loop system. 

Dealing with stigma, mental health, and access to care

In addition to physical challenges, the emotional toll that hormone therapy takes also contributed significantly to my diabetes management. 

As I was riding the roller coaster of emotions from HRT, my diabetes was also suffering. And the amount of cortisol my body was releasing was enough to send my numbers spiraling again. Let me be clear, rollercoaster or not, the emotions I felt had been necessary. Prior to my transition, I was not able to express anything. I was cold, angry, and depressed. These feelings made me feel more human than I ever have before. 

On top of that, dealing with gender dysphoria, expectations from societal standards of what a woman should be, as well as the discrimination many people in the LGBTQ community face – while also managing my diabetes – has led to increased stress and anxiety. 

One thing that many transgender individuals face is access to healthcare. I can recount a time recently when I went to receive a physical exam at an urgent care facility. The process of updating my name and having to explain my existence to the nurses and office staff was agonizing and very triggering for a transgender individual. 

Being called my deadname (previous name) repetitively while also having the incorrect pronouns is insulting as well as confusing. Hearing a deadname after you’ve transitioned can cause increased anxiety and emotional distress in a setting that may already be stressful. 

Transphobia (dislike or strong prejudice against transgender people) and a lack of understanding of transgender individuals' needs can create an environment where transgender and gender non-conforming individuals may not seek care or receive suboptimal care. 

In a survey of 27,715 transgender-identifying people, nearly 30% of respondents reported experiencing some form of healthcare discrimination or did not see a healthcare provider due to cost. In addition, 20% did not seek medical attention due to fear of discrimination. That’s why it’s crucial to provide comprehensive support that addresses both the emotional well-being and diabetes management needs of transgender individuals. 

The bottom line

Living with diabetes while undergoing a medical transition is challenging, but manageable and so beneficial with the proper support and knowledge. 

If one does not have support from friends and family, there is online support from groups such as the Ingersoll Gender Center; they operate a weekly Zoom meeting with a focus on transgender-related issues, including caring for chronic conditions like diabetes. 

Everyday life hands us new challenges, no matter if it’s work, school, family, or diabetes. We are designed to cope, push through, and do what is necessary to keep going. In the end, all I'm saying is don’t forget about yourself when facing these challenges. You may actually like who you are at the end of it all.

If you’re on the fence about transitioning or are worried that you won’t be able to handle a transition due to your diabetes, I am telling you to take the first steps (counseling, family therapy, and medical checkups) and do it. It’s never too late to be happy as your authentic self. 

Editor’s note: Defining terms

Some of the terms around this topic may be new or unfamiliar. Here are a few helpful definitions:

• Transgender: The term transgender (or “trans”) refers to people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth. This term is an umbrella term that captures many different experiences – there is no “right way” to be transgender.

• Cisgender: This term could be considered the opposite of transgender and describes someone whose gender identity aligns with the sex assigned to them at birth.

• Non-binary: This term describes a person who does not identify exclusively as a man or a woman. Non-binary people may identify with being both a man and a woman, somewhere in between, or completely outside these categories. Non-binary people may also identify as transgender, though not all do. Other similar terms which are often used to mean the same thing include agender, bigender, genderqueer, or gender-fluid.

• Transitioning/gender-affirming care: These include a number of processes that some, but not all, transgender people may undergo to live more fully as their true gender. This can include social (ex: wearing clothes that match their gender or changing their pronouns) or legal transitioning (ex: changing name and sex on government documents). It can also include medical transitioning or gender-affirming care which may include gender-affirming hormone therapy or surgery.