Medical considerations in the care of transgender and gender diverse patients with eating disorders

Abstract

Transgender and gender diverse (TGD) individuals are at increased risk for the development of eating disorders, but very little has been published with regards to the unique aspects of their medical care in eating disorder treatment. Providing gender affirming care is a critical component of culturally competent eating disorder treatment. This includes knowledge of gender affirming medical and surgical interventions and how such interventions may be impacted by eating disordered behaviors, as well as the role of such interventions in eating disorder treatment and recovery. TGD individuals face barriers to care, and one of these can be provider knowledge. By better understanding these needs, clinicians can actively reduce barriers and ensure TGD individuals are provided with appropriate care. This review synthesizes the available literature regarding the medical care of TGD patients and those of patients with eating disorders and highlights areas for further research.

Moving toward targeted eating disorder care for transgender, non‐binary, and gender expansive patients in the United States

“…This is notable because such dysphoric, incongruent features were reported to drive ED behaviors (e.g., restricting to reduce chest/hip size or cease menstruation). Participant 10, a non‐binary psychologist in ED recovery explains simply, “A lot of people turn to disordered eating to address gender dysphoria.” In keeping with this, a majority of participants (both groups) reported that weight restoration can be very difficult for TNG patients, as it often worsens gender dysphoria by enhancing distressing secondary sex characteristics (e.g., assigned‐female‐at‐birth: larger breasts, wider hips, resumption of menstruation, less angular face; assigned‐male‐at‐birth: larger abdomen, more muscular arms/shoulders) (Riddle & Safer, 2022). Several also noted that weight restoration targets—which historically have been set for cisgender patients based on binary sex norms—are unclear for TNG bodies, which complicates care (Geilhufe et al, 2021; Riddle & Safer, 2022).…”

“…It is generally reported in conjunction with fear of weight gain, fear of losing perceived positive aspects of the eating disorder, and low motivation for change, and has been previously reported as a main barrier to help-seeking in eating disorders among general patient populations (Ali et al, 2017). Particularly participants and clinicians identified a fear of weight gain with starting GAHT, which is a known side effect (Riddle & Safer, 2022).…”

Eating disorders in transgender and gender diverse people: characteristics, assessment, and management

“…Currently, there is still scant research on how to support trans people with eating disorders [50] ]. In an analysis of 10 trans patients receiving medical inpatient treatment for eating disorders, gender diverse adolescents were admitted to hospital for medical stabilization with a higher BMI than their cisgender peers but with equally serious signs of malnutrition [57].…”

“…Trans people with eating disorders commonly report feelings of judgement, otherness, and shame during recovery [58]. They also fear being misunderstood [50,58]. New tools have been developed for trans people recovering from eating disorders to connect with others in a similar situation [58,59].…”

“…A key tenet of gender-affirming care is that variations in gender identity and expression are natural, expected, and not pathological [29 ▪ ]. Gender incongruence and gender dysphoria experienced by trans people are best relieved by social acceptance and providing access to gender-affirming interventions [3 ▪▪ ,49,50].…”