Does being trans impact how you should eat?

Receiving gender-affirming hormone therapy, as a growing number of people in the U.S. are, can result in certain unique health needs, such as more mental health screenings and preventive care to track side effects from the medications. One area that doesn’t get a lot of attention: nutrition. It turns out that while taking hormones, you may need to adjust your diet in ways that researchers have only recently begun to explore, says Whitney Linsenmeyer, PhD, R.D., an assistant professor of nutrition and dietetics at Saint Louis University who specializes in transgender nutrition. Adding to the challenge? Dietary recommendations that address the nuanced needs of the trans community don’t exist yet, says Linsenmeyer, who also serves as a spokesperson for the Academy of Nutrition and Dietetics.

Here’s a closer look at what experts do know — and what they’re still investigating — about nutrition and gender-affirming hormone therapy (HT).

There is a decided lack of studies on optimal nutrition for transgender people. Up until recently, scientists weren’t exactly pouring time and energy into understanding people of marginalized genders, Linsenmeyer explains. An overdue shift finally got under way in 2016, when the National Institutes of Health recognized transgender people (along with the LGBTQIA+ community as a whole) as an official health disparity population. This designation helped open the door for dedicated research funding aimed at closing gaps in health outcomes. “There was a really dramatic uptick in research,” Linsenmeyer says. “Before that, there wasn't very much at all.” Even so, a robust body of scientific evidence doesn’t just materialize overnight (and funding can dry up when ruling political parties change).

Thus far, at least one major positive takeaway has emerged: For many trans and nonbinary people, it’s clear that hormone therapy, which is when someone takes hormones to help them look more like the gender they identify as, can be a vital, lifesaving form of medical treatment that reduces anxiety and depression, and improves overall quality of life. It does this, in large part, by inducing physical changes that ease gender dysphoria (distress over the differences between your gender identity and sex assigned at birth) and improve social functioning. If you’re transmasculine, hormone therapy might involve taking testosterone via injection, a topical gel, or a skin patch. Hormone therapy for transfeminine folks often includes oral estradiol (estrogen), commonly with progesterone and an androgen blocker such as spironolactone. (Important note: Not all trans people experience dysphoria, and not all trans people seek to medically or socially transition. The trans community is very diverse, and all trans identities are valid.)

As with pretty much every medication, gender-affirming hormone therapy can have unwanted side effects even as it produces health-promoting outcomes, Linsenemyer says. Estradiol for people assigned male at birth has been associated with reduced muscle mass, lowered resting energy expenditure that may set off weight gain, and elevated triglycerides (a.k.a. fats in the blood). 

Testosterone therapy for people assigned female at birth has been linked to elevations in blood pressure, as well as increased blood levels of harmful LDL cholesterol and decreased levels of beneficial HDL cholesterol. These findings are valuable because they help patients and care providers understand which health markers to monitor along the way — and give insight into how to adjust food intake to help counter those side effects.

It’s possible that dietary adjustments could make a meaningful difference for managing cardiovascular risks and other concerns when on hormone therapy, Linsenmeyer says, but it’s hard to say for certain. That’s due to a lack of research. Linsenmeyer co-authored a December 2020 review of 189 published studies on transgender nutrition and found that while 127 studies explored the health effects of gender-affirming hormone therapy and 64 identified nutrition-related health disparities in trans vs. cisgender people, only two studies explored nutrition interventions that might help. The conclusion: Many transgender people have distinct nutrition needs that warrant further investigation. Still to be determined: What the nutritional advice should be. 

Even if you aren’t taking hormones, being trans can make figuring out nutrition advice confusing. The 2025–2030 Dietary Guidelines for Americans makes zero mention of trans identities or transgender-specific concerns popping up in the published literature. Daily intake recommendations for key nutrients, including calcium, fiber, iron, zinc, vitamin A, vitamin C, vitamin K, niacin, and more — not to mention calories in general — continue to be broken down by sex: one amount specified for “males,” another amount for “females.” If your identity doesn’t fit in one of these two boxes, healthy eating can feel downright inaccessible, Linsenmeyer says.

While the broadest nutrition advice applies to basically all humans — eat a varied diet filled with whole veggies and fruits, lean protein, and whole grains, while limiting saturated fat, added sugars, and sodium — the particulars of trans nutrition may be tough to generalize, acknowledges Jami Zamyad, R.D., director of clinical nutrition at Stanford Children’s Health. “It's specific to the individual,” she says. That’s why, if possible, Zamyad recommends working with a trans-sensitive dietitian or nutrition counselor as you navigate hormone therapy. “Nutrition support [can] guide the patient in the right direction as far as what foods the person should focus on to feel better, feel healthier, and have a better transition,” she says. You could find one by searching “transgender-friendly nutritionist near me” or looking at OutCare’s provider directory. Through Weight Watchers you can also access a team of registered dietitians who practice non-biased, individualized care.

Research suggests that compared with cisgender people, trans people may disproportionately deal with certain dietary barriers that further affect nutrition status. 

• Disordered eating behaviors may be more prevalent in the trans community — likely stemming from the complex relationship between gender identity and physical presentation, Linsenmeyer says. 

• Access to affirming, high-quality health care may be another hindrance to healthy eating. Transgender people disproportionately lack access to insurance, and more than a quarter of trans respondents in the 2016 National Transgender Discrimination Survey said they had postponed necessary medical care due to concerns about anti-trans bias.

• Food insecurity is a concern for many trans people, as well, Zamyad notes. For example, a small 2020 survey of trans and gender-nonconforming people in the Southeast U.S. found that 79% had experienced food insecurity in the prior year, compared with about 11% of the general U.S. population.

There is no simple advice that can help with these larger issues, but organizations like GLAAD can be a good place to seek help and resources.

Although the research community is ramping up efforts to better understand diverse nutrition needs within the trans community, there’s still much to learn. Experts are working to develop evidence-based guidelines on how or whether a person’s diet should change when they start hormones, and how best to reconcile eating patterns with psychosocial needs around gender presentation.

As research continues, focus on things you can do today to support your health. Eating a diet rich in a variety of whole foods is a good move for everyone, as is regular physical activity. Understanding potential side effects of medications can help you respond promptly to issues that may arise. And if something feels off about your hormone regimen, nutrition status, relationship with food, or anything else, connect with a qualified provider for a personalized assessment. You deserve care and support for all aspects of your well-being.