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Where are the Current Eating Disorder Treatments For Transgender Missing the Mark?

It has been found that trans people are much more likely to develop eating disorders, but the current healthcare systems tend to often overlook the unique needs faced by them, which usually does more harm than good. With the number of individuals who identify themselves as transgender increasing dramatically over the last ten years, there has been a positive shift in society’s acceptance of transgender and gender non-conforming individuals. This same shift, however, has to also apply to the healthcare system.

While the signs and symptoms of eating disorders are more or less the same across the gender spectrum, but it has been seen that transgender people face many additional hurdles to their diagnosis and treatment of eating disorders. Read on to find out whether eating disorder treatments exclude transgender people.

Transgender People Are More Susceptible To Developing Eating Disorders

Many transgender people have said that their relationship with food and their body starts to change once puberty begins, primarily because of a lot of gender-related stuff at play.(1, 2, 3) Due to this, many trans people often try to remain as thin as possible. Due to this, they end up developing gender dysphoria, which is an extreme physical and emotional discomfort caused by the way in which they perceive their body as being incongruent with their gender. Gender dysphoria is believed to be a major contributing factor to the development of eating disorders. Research has shown that trans people are much more susceptible to developing eating disorders and also engage in disordered eating behavior as compared to cisgender people. And gender dysphoria is believed to play a huge role.(4, 5, 6, 7)

A study carried out in 2015, including over 289,000 college students, out of which 479 were transgender, concluded that the rates of eating disorder diagnoses as well as disordered eating behaviors were much higher amongst the trans students.(6)

Over 15 percent of all the transgender people that the study surveyed reported having been diagnosed with an eating disorder, as compared to just 0.55 percent of cisgender people, heterosexual men, and 1.85 percent of cisgender, heterosexual women.(6)

Risk Factors that Cause Eating Disorders in Any Population

While there are no clearly identified causes of eating disorders in any population, but there are several risk factors that are believed to contribute to these disorders. For trans people and cis people, many of the same risk factors hold true, such as trauma and food insecurity. However, trans people are more likely to experience eating disorders because of the stress of living in a transphobic society.

Trans people face many additional social, physical, and environmental experiences that influence the rates of eating disorders. For example, while not all transgender people experience gender dysphoria, many of them do, and they have to live with an increased scrutiny of their bodies. This sense of dysphoria makes it challenging for them to be accepting of being in their body, ultimately leading to eating disorders. Many eating disorders stem from how the body tries to adapt itself to overwhelming states of just being itself. As a result of this, you start developing other methods of not being in the body, or blunting physical development, or blunting certain sensations in the body.(8)

Even cis people can experience feelings of body dissatisfaction, but gender dysphoria is a different concept altogether. Gender dysphoria is usually a physical experience that an individual cannot tolerate. It is a sensation that can make you feel that your body is foreign, detached, or you feel terrified of your body because it is unable to align with your gender.(9)

It is also possible for gender dysphoria and body dissatisfaction to occur together. The dysphoria part, though, is usually a trauma that is specific to trans and non-binary people.

It is also important to note that most trans people tend to lack the social support needed to transition or access to the approved gender-affirming medical care, which includes hormone replacement therapy (HRT), puberty blockers, and surgery. Had this support been available, it could have helped ease the dysphoria and body disassociation.(10, 11)

As a result of all this, disordered eating may develop as an attempt to control the body’s gendered characteristics. For example, transmasculine people and trans men many times report restricting their food intake in an effort to shrink some body parts, including dysphorias, such as chests or hips, or to stop menstruation as well.(12)

Bullying and transphobic discrimination also have a role to play in the development of eating disorders in trans people, especially among the youth.(13, 14)

Where are the Current Eating Disorder Treatments For Transgender Missing the Mark?

Even though trans people are disproportionately susceptible to experiencing eating disorders and disordered eating, they face several prohibitive barriers that stop them from accessing treatment. These range from financial obstacles to transphobia within the medical care settings.

Some of the main challenges faced by trans people include:

  1. High Healthcare Cost and No Insurance Coverage

    On average, the cost of inpatient treatment for an eating disorder tends to range from $500 to $2000 per day. Patients may require three to six months or more of care at this level. And the cost of outpatient care may even cross over $100,000 over a period of time.(15)

    Trans folks often also face the problem with insurance coverage. For example, if you look at the state insurance of Oregon, there is only one inpatient treatment facility in the state, and the facility does not accept trans people as a patient. And if the treatment center does not work out, trans people are left out of options since their insurance does not cover alternatives.

    Research shows that trans people are much more likely to live in poverty and much less likely to have access to adequate health insurance as compared to cis people.(16)

    To help bridge these gaps, many organizations and advocates are actively working to provide free and low-cost treatment options for LGBTQIA+ people who are seeking treatment for eating disorders.

  2. Prevalence of Transphobia in Healthcare Facilities

    When trans people do have access to formal eating disorder treatment, many have reported a lot of issues that prevent the healing process. To begin with, it is challenging to find trans-informed doctors offering therapy for eating disorders. When doctors do not have a clear understanding of how gender dysphoria interacts with eating disorders, it usually leads to a disconnect.(17)

    Knowingly or unknowingly, doctors in eating disorder treatment facilities engage in both direct and indirect transphobia. For example, many facilities have rules that require trans people to have had certain expensive and physically demanding surgeries before they allow them to use the appropriate single-gender spaces. At the same time, not all treatment centers offer gender-neutral spaces that trans people are comfortable with or allow access to hormone replacement therapy.

    Many doctors and staff members frequently misgender trans people, and they have to ask the staff to give them access to an all-gender restroom. These requests are often ignored or even frowned upon. At the same time, there have been incidences where trans women or trans men have been denied access to a single-gender restroom. When treatment centers that are meant to help people heal end up subjecting patients to the same oppressive systems that ultimately caused the eating disorders in the first place, the effects are often even more serious. For example, in one study, several trans people wished that they had never gone to seek treatment for their eating disorder because of the transphobia they faced, even though they admitted that the treatment was lifesaving.(14)

  3. Dealing with Body Acceptance Issues

    The treatment for eating disorders focuses on body positivity or body acceptance frameworks that help patients learn to be accepting of their bodies. However, these frameworks are not very helpful when it comes to trans people and, in fact, can even cause further harm to them as these approaches involve trans patients being asked to accept the features of their bodies that induced the dysphoria in the first place.(18)

    Due to this research suggests that doctors who specialize in treating eating disorders should consider gender-affirming medical care as part of the recovery process for trans people who either want it or need it. Access to hormone replacement therapy has been found to reduce the risk of eating disorders for adults and youth.(19)

Conclusion: How to Make Eating Disorder Treatment More Trans-inclusive?

The first priority of doctors in eating disorder treatment should understand the unique needs of trans patients. There has to be an emphasis on gender affirmation, recognizing that trans patients are uncomfortable with their bodies in a different manner than cis people. For example, treating trans patients for eating disorders may even involve discussing surgery to reduce the appearance of their chest or other body parts that they are uncomfortable with as the first element of their recovery process. At the same time, if the dysphoria is being caused by menstruation, doctors should be understanding and able to discuss potential healthcare options, including hormone replacement therapy, to help slow menstruation, including intrauterine devices. All these out-of-the-box methods of treating eating disorders in trans people will go a long way in helping trans patients seek help.


  1. Coelho, J.S., Suen, J., Clark, B.A., Marshall, S.K., Geller, J. and Lam, P.Y., 2019. Eating disorder diagnoses and symptom presentation in transgender youth: a scoping review. Current Psychiatry Reports, 21(11), pp.1-10.
  2. McClain, Z. and Peebles, R., 2016. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatric Clinics, 63(6), pp.1079-1090.
  3. Nagata, J.M., Ganson, K.T. and Austin, S.B., 2020. Emerging trends in eating disorders among sexual and gender minorities. Current opinion in psychiatry, 33(6), p.562. Parker, L.L. and Harriger, J.A., 2020. Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. Journal of Eating Disorders, 8(1), pp.1-20.
  4. Diemer, E.W., White Hughto, J.M., Gordon, A.R., Guss, C., Austin, S.B. and Reisner, S.L., 2018. Beyond the binary: differences in eating disorder prevalence by gender identity in a transgender sample. Transgender Health, 3(1), pp.17-23.
  5. Diemer, E.W., Grant, J.D., Munn-Chernoff, M.A., Patterson, D.A. and Duncan, A.E., 2015. Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57(2), pp.144-149.
  6. Eatingdisorders.dukehealth.org. 2022. Gender Dysphoria and Eating Disorders | Duke Center for Eating Disorders. [online] Available at: <https://eatingdisorders.dukehealth.org/education/resources/gender-dysphoria-and-eating-disorders> [Accessed 14 April 2022].
  7. Dhejne, C., Van Vlerken, R., Heylens, G. and Arcelus, J., 2016. Mental health and gender dysphoria: A review of the literature. International review of psychiatry, 28(1), pp.44-57.
  8. Davy, Z. and Toze, M., 2018. What is gender dysphoria? A critical systematic narrative review. Transgender health, 3(1), pp.159-169.
  9. Gridley, S.J., Crouch, J.M., Evans, Y., Eng, W., Antoon, E., Lyapustina, M., Schimmel-Bristow, A., Woodward, J., Dundon, K., Schaff, R. and McCarty, C., 2016. Youth and caregiver perspectives on barriers to gender-affirming health care for transgender youth. Journal of Adolescent Health, 59(3), pp.254-261.
  10. Salas-Humara, C., Sequeira, G.M., Rossi, W. and Dhar, C.P., 2019. Gender affirming medical care of transgender youth. Current problems in pediatric and adolescent health care, 49(9), p.100683.
  11. LGBT Health. 2022. Disordered Eating Among Trans-Masculine Youth: Considerations Through a Developmental Lens | LGBT Health. [online] Available at: <https://www.liebertpub.com/doi/10.1089/lgbt.2019.0354> [Accessed 15 April 2022].
  12. Lgbtqiahealtheducation.org. 2022. [online] Available at: <https://www.lgbtqiahealtheducation.org/wp-content/uploads/2018/04/EatingDisordersBodyImageBrief.pdf> [Accessed 15 April 2022].
  13. Malina, S., 2021. Unique Causes and Manifestations of Eating Disorders Within Transgender Populations. Columbia Social Work Review, 19(1), pp.138-157.
  14. Google Books. 2022. Sex, Sexuality, and Trans Identities. [online] Available at: <https://books.google.co.in/books> [Accessed 15 April 2022].
  15. Transequality.org. 2022. [online] Available at: <https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf> [Accessed 15 April 2022].
  16. Taylor & Francis. 2022. Transgender Clients’ Experiences of Eating Disorder Treatment. [online] Available at: <https://www.tandfonline.com/doi/abs/10.1080/15538605.2016.1177806?journalCode=wlco20> [Accessed 15 April 2022].
  17. Hartman-Munick, S.M., Silverstein, S., Guss, C.E., Lopez, E., Calzo, J.P. and Gordon, A.R., 2021. Eating disorder screening and treatment experiences in transgender and gender diverse young adults. Eating behaviors, 41, p.101517.
  18. 2022. [online] Available at: <https://onlinelibrary.wiley.com/doi/10.1002/erv.2576> [Accessed 15 April 2022].
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:April 21, 2022

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