Nutrition and transgender people
Trans people, and the LGBTQIA+ population at large, continue to experience bigotry, discrimination, and injustice in health settings and other areas.
There's also a significant lack of research into trans health — including nutrition.
Because researchers have only recently started looking into these relationships, much of this article will be spent highlighting gaps in our understanding.
Before we leap in, a quick note on terminology.
We’ll use the terms “trans” and “transgender” interchangeably to mean someone whose gender doesn’t match the cultural expectations of their sex assigned at birth.
Some people transition, but this doesn’t always mean medically transitioning with hormone therapy or surgery.
A person might socially transition, which might involve using new pronouns or a new name. It might also mean changing the way you speak, dress, style yourself, and take up space.
A trans man is often someone who was registered as female at birth but who lives and identifies as a man. A trans woman is often someone who was registered male at birth but who lives and identifies as a woman.
And people who are gender nonconforming or nonbinary don’t identify with traditional ideas about the gender binary.
Cisgender people's sense of their gender aligns with that assigned to them at birth.
In our investigation into trans nutrition research, we’ll cover three main topics: nutrition guidelines, disordered eating, and food insecurity.
1. The guidelines gap
If you’ve ever looked up nutrition guidelines, you’ll have noticed that they tend to be split into “males” and “females.”
And the same goes for measurements like waist circumference and body fat percentage. Both are given for males and females.
In the United States, an estimated 1.6 million people aged 13 or older identify as transgender. But there are no specific nutrition guidelines for trans people.
A nutrition assessment is the first step in nutrition care. So, without research-backed guidelines, transgender people can fall between the gaps.
During medical transition
Research has shown that nutritional requirements shift, depending on the stage of your medical transition.
Also, different medical interventions can influence your health in a range of other ways.
For instance, in a study with 16 trans women and 31 trans men, estrogen hormone therapy in trans women was associated with reduced blood pressure. And testosterone therapy in trans men was associated with an increase in body mass index (BMI).
While one study concluded that metabolic effects of hormone therapy are “minimal,” some changes are more significant.
For instance, the authors of a review report that hormone therapy in trans men was associated with up to an 11.4% increase in BMI.
In fact, a study that looked at the rates of overweight and obesity in lesbian, gay, bisexual, and trans people found that trans men were most likely to have a BMI in the obese category.
Other studies in trans men have found links between hormone therapy and possible increased cardiovascular risk.
A healthy, varied diet can help reduce blood pressure, maintain a healthy BMI, and support heart health.
So, designing well-researched nutrition guidelines could help reduce health risks further.
2. Disordered eating
Trans people have an increased risk of developing an eating disorder. A primary driver of this is likely oppressive social stigma.
It’s almost impossible to entirely avoid internalizing other people’s negative opinions, which can put you at risk of developing negative beliefs about yourself. And it can take a lifetime of continual work to recover.
One study, which involved more than 280,000 students from 223 universities in the U.S. looked at self-reported eating disorders.
They found that transgender people were more than four times more likely to have received an eating disorder diagnosis in the past year than cisgender heterosexual women.
And trans respondents were twice as likely to have tried vomiting, diet pills, or laxatives in the past month.
To compound the problem, one study shows that when trans individuals seek treatment for disordered eating, they often experience “inadequate” care.
Mostly, this was due to the “clinicians’ lack of knowledge with regards to gender identity.” And none of the 84 participants reported having a positive experience.
Why the increased risk?
There are likely many reasons why eating disorders are more common among trans people. The authors of the study with over 280,000 student participants offer some insights.
They suggest that trans folks might use disordered eating to “suppress or accentuate particular gendered features.”
For transgender women, in particular, losing weight might be a way to conform to “feminine ideals of slimness and attractiveness.”
A participant in another study explained to the researchers that “Body fat and fat distribution have a lot to do with gender dysphoria, and sometimes trans people with eating disorders have them because they’re trying to manipulate their bodies without the use of hormones.”
Marginalization, stress, and health
Disordered eating might also stem from increased levels of stress.
For trans folks, this stress can come from many sources — including stigma. Trans people experience violence and discrimination in healthcare, employment, and housing, for example.
There can also be ongoing strains of concealing, reiterating, or defending identity, as well as significant social isolation.
One study involved almost 1,000 trans young people aged 14–25 in Canada.
The researchers found that those who’d experienced the highest rates of harassment and discrimination were more likely to report binge eating, fasting, or vomiting to lose weight in the past year.
On the other hand, those who reported “family connectedness, school connectedness, caring friends, and social support,” were less likely to have experienced disordered eating in the past year.
Stress is also linked to physical health problems.
A review on the relationship between minority stress and health found that nonheterosexual people “experience higher rates of physical health problems.”
Among them were problems related to heart and immune health, both of which a healthy diet can help support.
Of course, nutrition support can never heal all of these wounds, but the lack of guidelines is yet another gap that experts urgently need to fill.
3. Food insecurity
Many people in the U.S., United Kingdom, and beyond struggle to feed themselves and their families. According to research, transgender people are particularly affected.
For instance, a small study in the Southeast U.S. found that 79% of transgender and gender nonconforming people surveyed experienced food insecurity.
Despite this high percentage, only 19% used federal food resources, and 22% used local food resources.
According to the authors, many participants didn’t feel welcome at local food pantries, particularly those run by faith-based organizations, which made up the largest percentage of food pantry organizers.
Participants “suggested that food pantries may be unwelcoming due to the socio-conservative climate of the Southeast U.S.,” explain the authors.
We should note that most of the studies investigating food insecurity in trans population were carried out in the U.S., so the picture might be different in other regions.
However, while trans people globally fight for their rights to exist, providing access to food is the very least our societies can do.
For one study, researchers surveyed more than 80,000 high school students in Minnesota.
They found that transgender and gender nonconforming students were more likely to skip meals than cisgender students. They also consumed soda and fast food more often.
Bridging the gap
“Ultimately, nutrition therapy may play an important role in mitigating the known effects of hormone therapy and promoting the overall health of transgender and gender nonconforming populations,” explain the authors of one study.
In response to the lack of nutrition recommendations for the transgender population, the researchers also call for changes to the Nutrition Care Process to help build “a framework of gender-affirming care.”
Nutrition professionals use the process as a roadmap for providing nutrition care. It was designed by the Academy of Nutrition and Dietetics.
Research into nutrition for transgender people has grown in the last 20 years, particularly in the last 5 years. But there's still much more to do.
As we’ve seen, there are many challenges to overcome. And a first step can be raising awareness.
Aside from nutritional value, meals can bring joy and a sense of belonging.
Many people are working toward safer, more equitable access to food for trans people.
If you want to help, or if you need help, reach out when you can.
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