Gender-diverse individuals are disproportionately affected by disordered eating habits. Research estimates that 12% of transgender people have been diagnosed with an eating disorder at some point.
There are a LOT of stereotypes about eating disorders, and current psych culture is only beginning to move past those stereotypes. While we are beginning to understand how people of color, men, and other overlooked populations are affected by disordered eating, transgender identity is still invisible.
Gender-affirming care and strong social support are the strongest protective factors in preventing eating disorders amongst transgender people. Affirming care has been proven to be the most effective and ethical way to interact with transgender patients, although that does not mean all providers are equal.
Content Warning
This article discusses eating disorders, medical discrimination, and personal experiences of family rejection.
Crisis Resources:
If you or someone you love is struggling with disordered eating, remember that support is always available.
National Alliance for Eating Disorders
National Association of Anorexia Nervosa and Associated Disorders
If you reside outside of the United States, contact your local crisis hotline for immediate help.
The Statistics: What the Research Shows
Studies report that 12% of transgender people have been diagnosed with an eating disorder. Still, researchers estimate that the percentage is even higher since 30% to 50% of individuals screened positive for ED symptoms despite never being diagnosed.
In the general population, 9% of individuals report having been diagnosed with an eating disorder at least once in their lifetime, and 16% flagging positive during screening.
Results revealed that TGD individuals were more likely to exhibit elevated levels of EDs, DE, and BIC compared to cisgender individuals. Fewer differences in EDs, DE, and BIC between TGD groups emerged, although transgender men/transmasculine people had higher levels of restriction (vs. non-binary and gender diverse people) and compensatory behaviours (vs. transgender women/transfeminine people). Binary transgender people reported higher BIC than non-binary/gender diverse people.
Researchers are well aware that eating disorders affect all types of people, and folks with marginalized identities are exceptionally more likely to exhibit symptoms. That doesn’t equate to diagnoses, though.
Diagnosis requires being vulnerable for treatment and finding a healthcare professional well-versed in disordered eating – and hopefully other issues, too, like gender identity.
What is Disordered Eating?
Understanding disordered eating is the core of understanding eating disorders and discussing who exactly is affected by them.
For decades, eating disorders were described as white female conditions tied to excessive food restriction or vomiting. It wasn’t until recently that researchers broadened the understanding of “purging” also to include excessive exercise, which is a type of food restriction common in men.
Diet and exercise can be great things, but they can also morph into disorders when combined with too much stress. Eating becomes disordered when:
- You experience obsessive or intrusive thoughts about food, eating, and weight that interfere with daily life, such as dieting, calorie counting, body checking, micro-biting, compulsive exercise, and avoiding food-based social outings.
- You struggle to eat in front of others or in public.
- You develop rituals or rules around eating, such as eating foods in a certain order, cutting food into small pieces, purposely making food less appetizing, and avoiding certain foods entirely.
- You have body dissatisfaction that interferes with daily life and your ability to enjoy life.
- You frequently experiment with diets and eliminating food groups, such as believing “all carbs are bad.”
- You use exercise or purge behaviors as an antidote or “reward” for eating.
Barriers to Diagnosis and Treatment for Transgender Patients
Getting treatment for eating disorders can be a rough process, even if you’re willing. Healthcare providers are likely to overlook disordered eating habits and symptoms as part of broader gender dysphoria.
Ideally, treatment settings should be affirming and support one’s gender identity while receiving care. In general healthcare settings, 50% of transgender people reported needing to educate their own provider about transgender health.
Albeit limited, studies show that almost all transgender individuals receiving eating disorder treatment experienced misgendering, discrimination, and non-affirming care.
Multiple participants described barriers to affordable care… Other participants described difficulties finding providers who could provide holistic care, as well as a paucity of mental health providers.
Cultural responsiveness was also discussed as a barrier, with one participant raising concern that research and treatment have been primarily focused on white patients with economic means.
Other less frequently mentioned barriers included the lack of access to TGD specific ED groups as well as weight requirements for certain types of gender affirming surgeries resulting in the perception of physicians as gatekeepers for care.
Gender Dysphoria vs. Body Dysmorphia: Understanding the Difference
Gender dysphoria and body dysmorphia are distinct conditions, but they can co-exist. Gender dysphoria is distress induced from a mismatch between one’s assigned or assumed gender and internal identity. Body dysmorphia is an anxiety-based disorder that causes obsession over one’s perceived physical flaws.
At its core, gender dysphoria is all about one’s internal gender identity and the distress that comes from misalignment – which is why gender-affirming care is so effective at treating that distress compared to previous conversion techniques. Body dysmorphia occurs when someone has a distorted perception of themselves as ugly or defective, but has no connection to gender identity.
Why are Transgender People at Higher Risk for Eating Disorders?
Acceptance is perhaps the strongest protective factor against eating disorders in LGBTQIA+ people. In unaccepting environments, disordered eating provides control when transgender individuals may otherwise feel completely helpless.
I had a rough coming-out experience with my parents. After coming out, I was surveilled constantly so that my parents could ensure I was “trying” to be cisgender for their sake, which included dressing femininely, not talking to accepting friends, and being barred from online spaces. From religious sermons to moral condemnations, I heard every potentially awful thing one fears when coming out over that year and a half before moving out.
At the time, I felt I could not control any meaningful aspect of my person. I was no longer allowed to use my GC2B binder, I was being forced to grow my hair out, and I was even being forced to wear panties. I constantly walked on eggshells out of fear that the wrong move would create another lecture and outburst.
Disordered eating provided control over my physical body when I felt I had no other options. I had read somewhere online that food restriction could stop one’s period, and everywhere I looked, thinner bodies were more androgynous. If I weren’t allowed to bind or even consider a future of HRT, maybe I could try passing by losing weight from my chest and hips and working out.
Every morning, I would eat a half-cup of dry oats with a marginal amount of water – something that was readily available from my mother’s ongoing weight loss journey. 150 calories. Due to my family’s socioeconomic status, I had reduced lunches at school that allowed me the freedom to not eat what I wanted. For most school lunches, I had about 400 calories. After school, I’d purposely skip dinner and tell my parents I had eaten a free meal at work.
I began jogging more frequently, working out at the gym on my family’s pass, and looked up natural ways to boost testosterone. With my work income, I’d buy supplements from the supermarket like DHEA. I counted every calorie.
And I was successful – I managed to stop my period for months at a time, and I felt like I passed more frequently despite how long my hair had gotten. But everything felt obsessive. I vividly remember my AP chem teacher pulling me aside after class out of worry since my grade was slipping, but deflecting because any admission meant a possible phone call home, which meant another lecture. On my worst days, I didn’t eat out as a punishment to myself for being a bad kid to my parents because I genuinely believed I was corrupt.
After leaving home and starting transition, my disordered eating and self-harm habits stopped. However, a few years later, I had a falling out with a friend that left me completely isolated, and I began utilizing old habits and a spiritual downward spiral. I managed to pull myself back out with a new understanding of my boundaries and habits. Even today, it’s something I’m mindful of.
Transgender people are more likely to engage in disordered eating because they lack control over their physical and emotional boundaries. Additionally, eating disorders effectively limit and stunt secondary sex characteristics during puberty when transgender youth are unable to have gender-affirming care. Even amongst transgender adults, mainstream passing culture and transgender celebrities prioritize skinny bodies to reflect a thin beauty standard.
What Does Gender-Affirming Eating Disorder Treatment Look Like?
For gender-diverse individuals to get effective treatment for disordered eating, they must have access to quality care. Primary care providers, psychologists, and eating disorder professionals must be committed to understanding transgender identity to foster spaces where transgender folks are safe enough to be vulnerable and heal.
Due to its history, mental health treatment centers have a long way to go before getting the public’s trust as safe environments. Ideal treatment facilities will have publicly available information for transgender patients to view on chosen name and pronoun usage by staff.
Body-gender congruence through gender affirming social and medical interventions (e.g., hormone therapy) were noted as significant for alleviating body image problems and facilitating eating disorder treatment.
Treatment providers must understand gender dysphoria and transition goals to effectively help transgender people with eating disorders. Forcing a transgender person to gain weight they are avoiding to avoid appearing androgynous won’t be effective and cause significant distress. Eating disorder treatment needs to be integrated with gender-affirming care, such as HRT and general mental health services, to be optimal.
Treating ED[s]…can run directly up against interventions for tgnc [transgender/gender nonconforming] people. So…if you have an ED…you are often encouraged to practice radical body acceptance or do a lot of body meditations/somatic work where you are trying to push yourself to be in your body. While this works for many cis people, this is sort of the exact opposite of what works for tgnc people, allowing us to make choices about our body changes and helping us live with the dissonance between our bodies and brains.
Reframing Recovery: Why Body Neutrality Comes Before Body Positivity
We exist in an age where body positivity is highlighted. Contrary to what most might think, body positivity isn’t effective for helping those struggling with disordered eating. Forced positivity and mantras can help some folks, but there is a wide gap between their current reality and a potential future that seems feasible.
Body neutrality is critical to move people from distortion. You aren’t going to love your body suddenly after a few weeks of treatment. But you can see your body… as a body. Focus on how well it does from a purely functional standpoint on keeping you awake and alert. Separate thoughts of worth (both negative and positive) from appearance.
Eating disorder recovery doesn’t require you to love your body. The goal is to be functional.
How to Support a Transgender Loved One Struggling with Disordered Eating
It is distressing to see someone you love struggle with an eating disorder. As much as you love them, you alone won’t be able to fix them. Here are some practical tips for helping a transgender loved one with disordered eating:
- Express your concern appropriately. If you have identified potential warning signs, have a delicate conversation in a private setting where they won’t feel embarrassed or defensive.
- Avoid commenting on weight and body changes in everyday conversation, both positive and negative.
- Validate the frustration and distress of gender dysphoria, but don’t reinforce harmful behaviors.
- Don’t moralize food, like equating sweets or carbs as inherently bad.
- Recognize that it’s difficult to get help for disordered eating. Eating disorders provide a false sense of control and identity, so giving that up for treatment can be terrifying.
- Encourage and connect them with affirming professional care. Support their commitment to recovery and offer to accompany them to appointments if they’re especially anxious.
You are never alone. Even if transgender identities are largely invisible in current eating disorder treatment approaches, there is always help available, and you are worth fighting for.
References, Resources, & Further Reading
American Academy of Pediatrics. (n.d.). Policy statements and resources on transgender and gender-diverse youth. https://www.aap.org
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Association of Anorexia Nervosa and Associated Disorders. (n.d.). About ANAD. https://anad.org
Doley, J. R., et al. (2026). Exploring the differences in body image concerns and eating disorder symptoms between cisgender and transgender individuals: A meta-analysis.. https://pubmed.ncbi.nlm.nih.gov/41494283/
Hartman-Munick, S. M., et al. (2020). Eating disorder screening and treatment experiences in transgender and gender diverse young adults. Journal of Eating Disorders. https://www.sciencedirect.com/science/article/abs/pii/S1471015321000441
Heiden-Rootes, K., et al. (2023). A scoping review of research literature on eating and body image for transgender and nonbinary youth. Journal of Eating Disorders. https://pubmed.ncbi.nlm.nih.gov/37740228/
Maintenance Phase. (n.d.). Maintenance Phase [Audio podcast]. https://www.maintenancephase.com
National Eating Disorders Association. (n.d.). About NEDA. https://www.nationaleatingdisorders.org
Taylor, S. R. (2018). The body is not an apology: The power of radical self-love. Berrett-Koehler Publishers.
The Trevor Project. (n.d.). Research and crisis services. https://www.thetrevorproject.org
Trans Lifeline. (n.d.). About Trans Lifeline. https://translifeline.org
Erickson-Schroth, L. (Ed.). (2014). Trans bodies, trans selves: A resource for the transgender community. Oxford University Press.
World Professional Association for Transgender Health. (2022). Standards of care for the health of transgender and gender diverse people (Version 8). https://www.wpath.org
Food Psych. (n.d.). Food Psych [Audio podcast]. https://christyharrison.com/foodpsych