Transgender people, and the issues the community faces, are under-studied because national surveys of the general population fail to inquire whether a respondent is transgender. It has been estimated that 0.3% of U.S. adults identify as transgender; even though this population seems to be increasing. These citizens still face discrimination and disparities in healthcare; most health professionals are not adequatly trained to respond to and/or counsel patients. It is important for health professionals and patients to be educated about distinct nutritional challenges facing this community.
Regardless of your gender identity its important to exercise and consume a balanced diet in accordance with the Dietary Guidelines for Americans. The U.S. Department of Agriculture provides many resources on building a healthy diet through the ChooseMyPlate.gov website.
Weight and body image issues are common among this community. It is common for the transgender people to avoid the gym because of social pressures. Transgender men who have not had breast-removal may consume more calories to mask their upper body appearance. Transgender women may restrict calories and protein to maintain a thinner, less muscular structure. Overweight and underweight lifestyles can have detrimental long-term health consequences (e.g., increased risk of disease and premature mortality) that should always be taken into consideration regardless of an person’s gender identity.
Children have similar nutritional requirements until hormone suppressants are administered. This may impact bone growth and optimal development. The National Osteoporosis Foundation recommends that all kids and teenagers get enough calcium, vitamin D (preferably in the form of dairy) and physical activity daily to ensure strong bones.
Estrogen and sex hormones may alter one’s nutritional needs.
Transgender females face unique challenges. Estrogens can cause weight gain and may elevate triglycerides. Cutting out refined carbohydrates (e.g., added sugars, white bread/rice, etc) may help offset this spike in triglycerides. Iron requirements stay the same after full transition (i.e., a standard women’s multivitamin is not appropriate).
Transgender males also face unique challenges. Sex steroid therapy may increase LDL-cholesterol (i.e., bad cholesterol), therefore minimizing saturated fats and increasing dietary fiber may may help to avoid future heart health issues. Sex steroid therapy has been shown to increase visceral fat (i.e., the harmful fat), thus a healthy diet that is balanced in calories and exercise is important. It may also lead to bone loss, particularly among middle-age to older transgender men. So again, getting calcium and vitamin D through low or non-fat dairy consumption is key. Once menstruation has ceased, iron requirements fall from 18 mg to 8 mg per day (i.e., avoid a standard women’s multivitamin). Transgender men may also be prescribed diuretics that require a diet lower in potassium rich foods such as bananas and coconut water.
For more information on transgender health visit the University of Southern California, San Francisco’s Center for Excellence for Transgender Health.