OFM Health: Nutrition Considerations for Gender-Affirming Therapies
The transition process can be a long and tedious road, but ultimately, it can allow someone to feel more like their authentic and sexy self. Feel free to show it off—here are some things to consider so you can feel fabulous doing just that!
Calories Matter
Gender-affirming hormone therapy [GHT], such as testosterone [T] and estrogen, are but one way someone in the transgender community can get closer to their transition goals. These hormones can also significantly change your metabolic and nutrition needs. This means the calories you need may be different after starting GHT. Though the research is unclear at this time, many dietitians feel that it is best to support the calorie needs of someone’s gender expression, as opposed to biological sex, while they are on GHT. This is because the risk of unhealthy weight gain can be so great in the transgender community, mostly due to the side effects of GHT.
Since it is hard to say that a specific hormone therapy, such as T, can cause weight gain or loss across the span of people within the trans community, it’s best to keep an eye on individual weight changes. Keep in mind that weight changes may be related to an increase in bone or muscle mass, specifically in those on T. In those on progesterone, weight gain from fat mass is more likely. You can track changes in body mass using a body impedance analysis [BIA] machine typically found at a gym or fitness club. Still, it’s more important to track the foods you choose and any physical activity you engage in when looking at overall health. Weight is not an indicator of health.
If undesired weight gain starts, check to see if there are unnecessary, higher calorie foods in the diet—think processed or junk foods, high-fat or fried foods, and candy or sweets. There is no such thing as a “bad food,” but eating these foods excessively can help pack on the pounds, cause sluggishness, and even unintentionally promote depressive symptoms. With that said, eating higher calorie, nutritious foods—such as nuts, seeds, avocados, and full-fat dairy—can help someone gain weight if they find involuntary weight loss occurring. Generally, everyone should avoid foods high in saturated and trans fats.
Hormone-Specific Suggestions
GHT is not without its inherent, nutrition-related concerns; however, the benefits of reaching someone’s transition goals can mean feeling free to live their best, healthful life. Still, many individuals on hormone therapy can experience weight gain and glucose intolerance (which can lead to diabetes). This is one of the reasons why focused nutrition supports the transition process. As for specific considerations regarding hormone therapy:
Testosterone: T increases muscle mass and may increase bone mass, at least in the short term. However, long durations of T may decrease bone mass and contribute to an increased risk of osteoporosis. This means checking Vitamin D levels and eating foods higher in calcium, such as leafy greens and dairy. Additionally, the effects of T may significantly reduce or eliminate the menstrual cycle, which would impact iron needs. Unnecessarily taking iron supplements may lead to constipation.
Estrogen: May increase risk of blood clots and progesterone may cause weight gain. In those who have their testicles removed, estrogen replacement can play an important role in preserving bone mass. Compared to cisgender women, whose natural estrogen can decrease over time, consistent estrogen replacement use has been shown to have no negative long-term impacts on bone density.
Don’t Forget to Move
For those whose GHT may cause weight gain or a change in bone mass, physical exercise becomes pretty much essential. Exercising doesn’t mean going to the gym, but it does mean weight-bearing exercises that strengthen bone mass and promote a healthy metabolism. Weight-bearing exercises include lifting, cardio with weighted bands around the ankles or wrists, calisthenics (like pushups), and even some types of yoga. Not only can exercising promote overall health, but it is known to build confidence and self esteem. In a world where society relies on unrealistic physical stereotypes, having self esteem is key to your own sexiness.
Celebrate You
Wherever a person is in their transition, their journey is their own. Living your best life nutritionally is one of the best ways to celebrate who you are and promote health at the same time. The role of the registered dietitian is to help all people along the gender spectrum receive focused nutrition tailored to their personal needs and goals. For those within the transgender population on GHT, this means reducing the risk of certain conditions (like glucose intolerance), engaging in healthful eating behaviors, and making any appropriate changes (such as those mentioned above) when starting GHT. While there are plenty of considerations to make when on GHT, the most important things are to listen to your body, enjoy all foods without guilt, and speak to a registered dietitian to see what is right for YOU.
