No guidelines exist regarding nutrition assessment for transgender or gender non-conforming patients. Multiple nutrition assessment methods utilize gender-specific values that provide distinct recommendations for males and females. This clinical case series depicts the food and nutrition considerations of ten adult transgender men using anthropometric, survey, and dietary recall data. Male reference values were used to analyze patient data, though multiple approaches to nutrition assessment in the transgender population are discussed. Major nutrition-related concerns were obesity, low fruit and vegetable intake and high sodium intake; disordered eating was not a prominent concern. Further research is needed to inform nutrition care for the transgender and gender nonconforming populations.

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Objectives The purpose of this study was to explore the lived experiences of transgender men related to nutrition, exercise, and body image throughout their transition. Our objectives were to 1) describe changes in attitudes and awareness related to nutrition, exercise, and body image throughout the process of transitioning, 2) explore the persistence of feminine or masculine schemas related to these variables, and 3) capture the role of nutrition and exercise as physical embodiments of gender expression. Methods We utilized narrative inquiry and a hybrid biographical, psychological and linguistic approach. The primary investigator conducted semi-structured interviews with ten adult transgender men. Each interview was crafted into a brief narrative and major themes were constructed across the narratives. Strategies of trustworthiness included member checking of the narratives and preliminary results, triangulation of multiple theories, reliance on four research team members in data analysis, and use of verbatim quotes. Results Five themes were constructed: Coming to life as a man; caring for a new body; expected and actual changes with hormone therapy; health information seeking; balancing the demands of daily life. Each theme was supported by three to five subthemes. A sample of the ten narratives reads: “CM is a 33 year-old transgender male and has been on hormone therapy for over five years. He gained about 60 pounds after starting hormone therapy due to an increase in appetite and a genuine desire to have a larger body size. He describes, “I'm not going to blow over and am just more rugged, solid, stocky” and going from “invisible to visible.” CM is now motivated to care for his health and longevity. He explains, “I really like my life now. It feels great! I get to be a husband. I get to do these things. I get to live my life as I am.” Conclusions Transgender men's relationship with nutrition and exercise generally improved throughout their transition second to improved body congruence and increased motivated to care for a new body. Healthcare providers can work with their transgender patients to better understand their goals for transitioning related to body size and shape, and can communicate how nutrition and exercise may play a role. Funding Sources This project was funded through an intramural grant at Saint Louis University.

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