When you start to dig into the why behind these numbers, it’s easy to identify various risk factors that transgender populations face: rigid appearance ideals, minority stress, discrimination, higher rates of food insecurity and trauma, and gender dysphoria, just to name a few. Gender dysphoria—significant distress, discomfort, or misalignment with one’s gendered body experience—can play a particularly big role in the development of an eating disorder, feeding into both psychological distress and body image issues. In fact, 32% of transgender people report using their eating disorder to modify their body without hormone replacement therapy.
For all of these reasons, it’s essential for providers to take a specialized and nuanced approach when working with transgender eating disorder patients—and one of the core tenets is incorporating a gender-affirming care protocol. We’ve already explored the best ways providers can support transgender eating disorder patients, but gender-affirming care is such an important topic that we wanted to focus on it specifically. To shed more light on this important topic, Jessie Menzel, PhD, Equip’s VP of Program Development, answered some of the most common questions providers have about gender-affirming care for eating disorder patients.
What is gender-affirming care? And what is a gender-affirming care protocol?
When a person’s gender identity conflicts with the sex they were assigned at birth, gender-affirming care is care that helps them bring all aspects of their life into alignment with their gender identity so that they can live as their authentic self.
It is an approach to working with patients that respectfully affirms their gender identity, considering all the physical, mental, and social aspects of their well-being. This could encompass anything from medical interventions to social services to counseling or therapy.
How does gender-affirming care show up in eating disorder treatment? Why is it so important?
Transgender and gender expansive (TGE) people are at increased risk for developing eating disorders in large part because the considerable amount of stigma and discrimination they experience in our society. And trans and non-binary people are not immune from the harms of cultural appearance ideals, either—and the ideals for people in these communities can often be more extreme or even necessary for safety reasons.
However, individuals who also experience gender dysphoria (the distress that results from a discrepancy between one’s gender identity and their physical characteristics) are at unique risk for developing eating disorders. Someone who is TGE may engage in extreme attempts to alter their body by preventing weight gain, losing weight, or striving for a certain physique in order to align their body more closely with their gender identity. In these cases, it’s impossible to separate out someone’s gender identity from their eating disorder, and it will be necessary to address gender dysphoria in order to successfully treat the eating disorder. Therefore, gender-affirming eating disorder care is care that addresses a person’s identity and eating disorder concurrently.
What should I look for in treatment providers to ensure they incorporate gender-affirming care?
If you want to refer a TGE patient to an eating disorder specialist or program, it’s essential to find one that takes a gender-affirming approach. The first indicator that a provider is gender-affirming in their approach is if they ask! Do they ask you about your patient’s gender identity and pronouns? Do they ask about their trans experience and whether or how gender identity has impacted the development of an eating disorder? Beyond asking, you’ll also want to make sure that the provider has received training in gender-affirming care or if they work with or can refer to gender specialists. Most importantly, your patient should feel safe to be open about their identity and have that identity be affirmed in every aspect of the treatment experience.
- Diemer, Elizabeth W et al. “Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students.” The Journal of adolescent health : official publication of the Society for Adolescent Medicine vol. 57,2 (2015): 144-9. doi:10.1016/j.jadohealth.2015.03.003
- Duffy, Mary E et al. “Transgender Clients' Experiences of Eating Disorder Treatment.” Journal of LGBT Issues in counseling vol. 10,3 (2016): 136-149. doi:10.1080/15538605.2016.1177806
- Guss, Carly E et al. “Disordered Weight Management Behaviors, Nonprescription Steroid Use, and Weight Perception in Transgender Youth.” The Journal of adolescent health : official publication of the Society for Adolescent Medicine vol. 60,1 (2017): 17-22. doi:10.1016/j.jadohealth.2016.08.027
- Milano, Walter, Paola Ambrosio, Francesa Carizzone, Valeria De Biasio, Giuseppina Foggia, and Anna Capasso. “Gender Dysphoria, Eating Disorders and Body Image: An Overview.” Endocrine, Metabolic &amp; Immune Disorders - Drug Targets 20, no. 4 (2020): 518–24. https://doi.org/10.2174/1871530319666191015193120.