Trans people are much more likely to experience eating disorders, but current care systems overlook their unique needs and often do more harm. These advocates are working to change that.
Bee, a transgender, genderqueer person living in Portland, Oregon, once worked as a therapist serving trans, nonbinary, and intersex clients with eating disorders (EDs).
Now, they’re back in recovery from their own ED.
Bee, 36, was diagnosed with anorexia nervosa at 14 and entered recovery for the first time as a teen. They identified as recovered by their 20s, but during the COVID-19 pandemic, they said, they experienced “a full-blown relapse.”
Bee said their trans identity influences their ED, as it does for many people. Yet, they said that frontline ED treatment modalities often exclude, erase, or even harm trans folks in recovery.
Experts and advocates say that Bee is far from alone in feeling that way.
Trans people are more likely to experience eating disorders
Bee said their relationships with their body and food began to shift when puberty started.
“While I wasn’t necessarily cognizant of it at the time, looking back at it, there was definitely a lot of gender stuff at play,” they told Healthline. “I was just trying to take up as little space as possible.”
They said their gender dysphoria — extreme physical and emotional discomfort caused by perceiving your body as incongruent with your gender — continues to contribute to their ED.
Research suggests that trans people are much more likely to develop EDs and engage in disordered eating than cisgender people, and dysphoria likely plays a role (
A study including more than 289,000 college students, 479 of whom were transgender, found that rates of ED diagnoses and disordered eating behaviors were much higher among trans students (3).
More than 15% of the trans people surveyed reported ED diagnoses, compared with 0.55% of the cisgender, heterosexual men and 1.85% of the cisgender, heterosexual women (3).
Unpacking the disparity
While there are no clear causes of EDs in any population, several risk factors appear to contribute.
Trans people can contend with many of the same risk factors as cis people, such as trauma and food insecurity, but they may be more likely to experience them as a result of living in a transphobic society, according to Hannah Coakley, MS, RD.
Coakley is a nonbinary, queer dietitian who works with clients in ED recovery through their private practice, Pando Wellness, in New York. Nearly half their clients identify across the transgender spectrum.
Coakley said trans folks face additional social, environmental, and physical experiences that influence the rates of EDs. For example, while not all trans people experience gender dysphoria, many do — and they’re subjected to increased scrutiny of their bodies.
While cis people can experience body dissatisfaction, gender dysphoria is different. It’s often an “intolerable physical experience,” Coakley said — one that can make your body feel foreign, detached, or terrifying because it doesn’t align with your gender.
Gender dysphoria and body dissatisfaction can co-occur. The dysphoria element, though, is a trauma specific to trans and nonbinary people.
Many trans people lack social support to transition or access to the gender-affirming medical care — including puberty blockers, hormone replacement therapy (HRT), and surgery — that can help ease dysphoria.
As a result, disordered eating may emerge as an attempt to control a body’s gendered characteristics, according to Coakley.
For example, trans men and transmasculine people sometimes report restricting food intake in order to shrink body parts that induce dysphoria, such as hips or chests, or to stop menstruation (5).
It’s not just gender dysphoria itself: Transphobic discrimination and bullying may also affect EDs, especially among youth (6, 7).
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