Diversity Spotlight Topic

Health and Nutrition Considerations for Youth who are Transgender

By: Mary Kuester, RD and Jaime Moore, MD MPH

(Topic conceptualization: Breta Alstrom, RD)

Key Terms:

LGBTQ - Lesbian Gay Bisexual, Trans, Queer or Questioning
Transgender - individuals whose gender identity differs from the sex assigned at birth
Cisgender - individuals whose gender identity matches the sex assigned at birth

Members of the LGBTQ Community frequently find it difficult to access gender affirming care. Consequently, the are less likely to receive regular medical care. Transgender youth often find it difficult to report sexual identity to their clinicians. Patients need a nurturing environment with open communication, empathy, respect, without judgment to feel comfortable disclosing gender identity.

Members of the LGBTQ community are at higher risk for:

  • Substance use
  • Sexually transmitted diseases
  • Cancer
  • Cardiovascular disease
  • Obesity
  • Bullying
  • Isolation
  • Rejection (may lead to homelessness)
  • Physical/sexual abuse
  • Anxiety, depression, and suicide

Based on the Minnesota Student Survey (n=80,929 9th & 11th graders), Rider et al., Pediatrics, 20181:

  • 62% of youth who were transgender or nonconforming (TGNC) reported general health as poor, fair or good vs. very good or excellent compared to 33% of cisgender youth.
  • 52% of TGNC youth reported long term mental health problems vs. 17% in cisgender peers.
  • TGNC youth had lower rates of preventive medical and dental check-ups during the previous year

Nutrition considerations in youth who identify as transgender:  

  • Changes in body weight:
    • Weight gain and changes in body composition may be seen with gender affirming care (e.g. hormone therapy),2 which may differ by stage/type of therapy.
    • Weight change associated with pubertal blockade
    • Intentional weight gain to hide gender related features such as curves (related to body dissatisfaction and/or to conform to gender ideals)
  • The prevalence of obesity is higher in both young adult transwomen and transmen.3
  • Eating disorders/disordered eating
    • Prevalence is higher in the transgender community than in cisgender counterparts.2 Rates of diagnosis may be higher because gender affirming care requires a mental health assessment/treatment component.
    • Currently, most eating disorder screening tools are designed for cisgender females which may make identifying eating disorders more difficult in other groups.
    • Transgender youth might use disordered eating behaviors (bingeing, purging, restricting etc.) to change their body shape or size to cover gender or to conform to identified gender.
    • Provision of gender affirming care may improve eating disorder treatment outcomes. Without this, patients often resume disordered eating behaviors after treatment.
  • A recent scoping review concluded that there is a clear need for research evaluating effective nutrition methods and interventions for individuals who are transgender.4  

References

  1. Rider GN, et al. Health and Health Care Utilization of Transgender and Gender Nonconforming Youth: A Population-Based Study. Pediatrics. 2018;141(3). PMID: 29437861
  2. Rahman R and Linsenmeyer WR. Caring for Transgender Patients and Clients: Nutrition-Related Clinical and Psychosocial Considerations. Journal of the Academy of Nutrition and Dietetics. 2019;119(5). PMID: 29779913
  3. Klaver M et al. Hormonal Treatment and Cardiovascular Risk Profile in Transgender Adolescents. Pediatrics. 2020; 145(3). PMID: 32102929
  4. Rozga et al. Hormone therapy, health outcomes, and the role of nutrition in transgender individuals: A scoping review. Clinical Nutrition ESPEN. 2020; 40. PMID: 33183572 

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