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HEALOR
September 9, 2023

How Eating Disorders Can Affect Transgender People

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Eating disorders are difficult for anyone, but they affect transgender people differently and harshly. Trans people have a very high prevalence of eating disorders due to our intersecting mental health difficulties, and we deserve treatment all the same. Stick with me for a discussion about this important topic, and learn some ways to care for nutrition during transition.

A quick intro: Hi, I’m Summer and I’m HEALOR™ new blog writer. I hold a Master’s in Psychology, and I’m keenly interested in wellness, mental and physical. For my first piece, I’d like to explore an under-discussed topic that’s pretty close to my heart.

Eating Disorders in transgender minds

Eating disorders are an umbrella of experiences and diagnoses involving eating habits that are damaging to well-being. They appear in many thought patterns and behaviors and do not always correspond to high or low body weight. Many people who have eating disorders appear ‘healthy’ but experience serious emotional distress. Once the disorder progresses, it can weaken the immune system, worsen mental health, and permanently damage the vital organs.

Eating disorders are strongly related to self-esteem, social settings, and feelings of control. Many disordered behaviors involving food can be traced to a loss of control or an intense desire for control. These are often tied to cultural expectations of how a person ‘should’ look in their family or society.

While not all transgender people experience gender dysphoria, most of us do. Gender dysphoria often manifests as a negative feeling about our appearance. Gender dysphoria is also a massive contributor to depression and anxiety, which can disrupt our self-image and eating patterns. There are also emotional consequences to being transgender in the face of discrimination: we often have a punishing desire to be read as our gender (or ‘pass’) so that we can live peacefully. We’re also influenced by expectations of how cis and trans people ‘should’ look in media and society.

To recap: our self-esteem is often shaken and tied to a desire to change our bodies. We are at enormous risk of depression and anxiety. We live with high social pressure to change ourselves for the benefit of others. For these reasons, being transgender places us in a perfect storm of risk for eating disorders.

Can eating disorders affect trans people differently?

Short answer: yes!

Most research into eating disorders is done on cisgender people. It also prioritizes the young, cis women who make up the majority of diagnoses. This isn’t unreasonable, but the data has left trans people behind.

Eating disorders are very gendered, and trans people experience gendered expectations and roles differently to cis people. Cisgender American women are diagnosed more than twice as often as men for anorexia and bulimia nervosa but are by no means the only people affected.

Where trans people differ is that we experience eating disorders alongside the bodily dissatisfaction of gender dysphoria and other mental health challenges. This leads to higher rates of eating disorders among adolescent and young adult trans people. Our situation is made worse by the fact that treatment can be very trans-exclusionary.

Some of the ways these disorders can manifest in trans people are:

  • Using disordered eating to modify the body without hormone treatment
  • Developing disorders alongside body dissatisfaction and dysphoria
  • Non-binary people restrict their weight to be thinner, in line with androgynous stereotypes

What can trans people do about this risk?

It’s important, to be honest, and willing to ask for help. Eating disorders thrive on dishonesty: they fill our minds with falsehoods about how we look, and how we ‘should’ look to be more valid human beings. They prey on our anxieties and trauma to warp our self-esteem. Mental distress like anxiety, depression, and eating disorders are insidious because they damage the ability to self-assess our well-being or make recovery decisions. Mental distress is punishing because it damages our agency.

If you see warning signs like a strong interest in modifying body weight or starting heavy, unsupervised exercise, it’s good to seek other opinions. Healthy weight loss is possible, but it is best done with medical supervision. If you're interested, read resources from advocacy groups to see if your feelings align with eating disorders. If you have a GP or therapist, consult them for an expert opinion.

Remember that eating disorders aren’t just about weight. They’re about emotional distress and control (or loss of control). Distressed thoughts and behaviors merely become a vehicle for the bodily changes. Managing weight without addressing the underlying thought patterns is often unsustainable. Recovering from harmful mental patterns can bring wholesome well-being, even if bodily health takes time to follow.

Reflect on your eating as part of your collective well-being. Disruptions in eating or sleep are one of the first signs that something is amiss and there’s a reason that doctors ask about them. Reflection is really important for dysphoric trans people impacted by dysphoria and other mental stressors. Ask yourself if you’ve been eating as much as you’d like to. Ask yourself if you’re comfortable with how much you eat. Ask yourself if other stressors in your life are challenging your self-esteem.

And lastly, remember the difference between healthy and unhealthy desires. Most trans people are familiar with the dreadful assertion that being transgender is something that needs to be 'treated'. Having gender dysphoria and an eating disorder can entrench this because the dysphoria and eating disorders often stem cast similar shadows. Both stem from profound disruptions in self-esteem and bodily satisfaction, and both come with a strong desire for changing oneself.

The reason that eating disorders should be countered and transition should be supported is a fundamental difference in outcomes. The natural outcome of letting a well-supported gender transition is a happier, more vibrant person. The natural outcome of an unmanaged eating disorder is physical and mental deterioration, with a high risk of death. The harms of transition are often attached to discrimination and healthcare denial. The harms of eating disorders are societal and psychological. Always remember that your gendered self is valid, with or without the challenges that accompany it.

But most importantly…

Seek help when the time is right. Once you feel ready to talk to a clinician about your eating habits, don’t hesitate to make the call. Like any form of mental distress, earlier is better for long-term care. Mental distress isn’t always treatable through medicine alone, and disordered eating is a star example of this. The best cases of recovery come from dedicated clinicians, social support (family and friends), and personal effort. Recovery isn't a slope of continuous progress, either. It's full if missteps, relapses and learning.

But from someone in recovery – it’s never too late to try.

Note: This article was reviewed by Dr. Raj Singh prior to publication.

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