by Katie Hardison
Clinical Dietitian
In 2018, the Trevor Project partnered with the National Eating Disorders Association (NEDA) and Reasons Eating Disorder Center to complete the first national survey of LGBTQ youth focused specifically on the relationships between sexual orientation, gender identity, eating disorders and suicidal ideation. This first of it’s kind survey found that:
40% of respondents who identified as gender non-conforming and genderqueer,
39% who identified as transgender male,
and 12% who identified as transgender female -
had been diagnosed with an eating disorder.
For the last 4 years, I have worked as a dietitian with transgender and gender diverse youth, many of whom have disordered eating patterns. As with disordered eating patterns in cisgender folks, the cause of these disordered eating patterns is multifaceted and often difficult to determine.
Patients have told me that they changed the way they eat so they could decrease their chest/hip size, stop their menses, or reduce their musculature. Some patients have begged me for foods that will increase their chest size or some have cried that they are too scared to drink soy milk for fear of the effects it will have on their testosterone levels.
Many of my patients are getting the majority of their information from the internet where anybody can go online, start a TikTok or Instagram account and call themselves a nutritionist, an unregulated credential in most of the United States.
I am usually the first person who has had any formal nutrition education or training that they have spoken to, and we spend many visits dispelling rumors and misinformation. For example, research does not show that soy milk intake effects testosterone levels in transgender or gender diverse youth.
Parents and caregivers of my patients are often unaware of the signs of disordered eating including fasting, skipping meals (including breakfast), and eating very little.
Some disordered eating patterns like vomiting after eating or taking diet pills or laxatives are a bit more obvious; but even sudden changes in diet to Vegetarianism or Veganism with little explanation or beginning a new exercise regime that appears excessive can be a red flag that something more may be going on with that person.
Oftentimes what parents and caregivers tell me they see is their kids eating excessive amounts of food in the afternoon/evening not realizing that this may be the first or only meal their child has had that day.
Identifying the problem early on and getting help are the best actions to stop disordered eating from becoming an eating disorder.
So what does getting help look like? Each person’s journey through recovery from disordered eating is different, so I will give you a guide on what has worked best for many of my patients.
Most critical is a good therapist/counselor/psychologist who is gender-affirming and able to discuss the relationship between food, mood, and body image; usually a gender-affirming dietitian is a good idea too, so they can discuss nutrition, food, and challenge any thoughts or beliefs that may have been learned from less desirable places, like social media or the internet; a medical provider who can manage any of the physical symptoms of disordered eating, of which there are many; and sometimes a psychiatrist or family therapist is necessary too.
Unfortunately, like many things involving the transgender and gender diverse community, there is not enough research yet into disordered eating in the community and how treatment outcomes may differ from their cisgender peers.
There needs to be more clinicians who are able to discuss both disordered eating and the role gender identity may play in it. If you or a loved one is struggling with an eating disorder or disordered eating, please call the NEDA Helpline at 1-800-931-2237 where you can receive guidance and support.