The risk of eating disorders in transgender men and women

For years, eating disorders have been deemed a “women’s issue.” Many believed the illnesses, such as anorexia and bulimia, primary affected teen girls. However, we now understand that eating disorders affect people of all ages and genders, including transgender people.

Transgender — sometimes referred to as trans — is an umbrella term for people whose gender identity, expression or behavior does not conform to that typically associated with the biological sex — male or female — they were assigned at birth.

Many transgender people experience anxiety, depression, substance use and eating disorders, which may be due to feelings about their body. Transgender people can also experience difficulties receiving care and the lack of support to freely express their gender identity. In fact, a recent study on American college students found that transgender students reported eating disorder symptoms approximately four times more than their cisgender — those whose gender identity matches the sex that they were assigned at birth — classmates.

“Transgender individuals may be at risk of developing an eating disorder because of a desire to attain cultural ideals of gender and beauty,” says Linda Santangelo, PhD, lead clinical psychologist at the eating disorders program at Sharp Mesa Vista Hospital. “This striving to meet the ideal body standards may be an attempt to be accepted as their identified gender.”

Eating disorders are complex among all people

According to Dr. Santangelo, transgender males — people assigned the female gender at birth who identify as male — may desire a body that is free of secondary sexual characteristics, such as breasts, large hips and adequate hormones to support menstruation. Similarly, transgender women — those assigned the male gender at birth who identify as female — may desire a more thin or curvy body to adhere to the cultural female ideal.

However, Dr. Santangelo stresses that it is important not to generalize. Eating disorders are complex and their cause can stem from a multitude of factors. While some transgender people who have eating disorders may try to change their bodies to match their gender identity, this is not true for all.

There are no specific treatments for transgender people with eating disorders. However, because people with eating disorders and transgender individuals have higher rates of suicide, close attention to issues of safety is paramount.

“Eating disorders are treatable and transgender people are best served by a comprehensive team that includes mental health professionals specifically trained in eating disorders as well as gender-affirming care,” says Dr. Santangelo. “Treatment should also include support and assistance for those individuals who want to pursue hormone or surgical interventions to alter their bodies instead of merely focusing on body acceptance.”

Talk with your doctor if you or a loved one are concerned about disordered thoughts or behaviors related to food. Sharp Mesa Vista Hospital offers a specialized eating disorders treatment program and gender-affirming care.