INS and Insulin resistance: Transgender women had worsened insulin resistance, HOMA-IR, (mean 1.7, 95% CI 1.3–2.1, P = 0.001), and increased early insulin response. Transgender men had improvement in hepatic insulin sensitivity, HOMA-IR decreased, mean 2.4, 95% CI 1.8–3.0, P = 0.004).