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.

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.

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.

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). 

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.

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. 

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.” 

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.

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.

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.

However, while trans people globally fight for their rights to exist, providing access to food is the very least our societies can do.

Ultra-processed food

Because ultra-processed foods are relatively cheap, they are often more accessible. So, people experiencing food insecurity may be more likely to buy these foods.

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. 

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. 

Moving forward

Aside from nutritional value, meals can bring joy and a sense of belonging.

There are trans dinner clubs and spaces where trans people of color eat for free.

Also, trans mutual aid funds are growing in number, from New York to Wales. They’re available in several areas of the U.K. and U.S.

If you want to help, or if you need help, reach out when you can.