Nutrition and Exercise for Trans People

For someone who is transgender, food (nutrition), and exercise are often essential and can play a role in easing their transition. Lower body fat reduces the risk of post-operative infections and also reduces risks like blood clots, high blood pressure, and cardiovascular disease, which are usually higher in people on hormone replacement therapy. A balanced diet can also help your body to regulate hormones and changes in hormone levels.

Unfortunately, peer-reviewed research studies on the effect of nutrition on gender transition are few and far between, and it is only in recent years that the number of interested healthcare providers has risen, and with it, the number of scientific studies.

Furthermore, there are still some healthcare practices that need revision to account, not only for the diversity in genders but also the diversity of humanity as a whole.

There are some countries that have bodyweight restrictions for surgeries (not only gender-affirming surgeries, but many other types of surgeries as well), so having a healthy weight will likely count in your favor when discussing surgical options. A regular exercise routine can also help battle things like depression, and because there are so many different exercise routines available, there are even some that could help you combat gender dysphoria by helping you to shape your body.

Why is Nutrition Important?

Nutrition is vital for transgender individuals, and the reasons for this are extensive. Mainly, good nutrition and a correctly balanced diet will help to work against some of the side effects of hormone treatments—specifically things like bone density problems and the increased risk of thrombosis or high blood pressure.

Another significant reason why nutrition and diet are so important for transgender people is because of the calorie requirement difference between biological sexes (which is based on hormone-regulated metabolism). For example, the average daily calorie requirement for a cisgender man is 2,500, whereas the daily requirement for cisgender women is only 2,000. When you first started HRT, this was probably one of the things you had to adjust to because changing your hormone levels means changing your calorie requirement as well.

When we talk about calories, we also need to remember that your final calorie requirement will depend on your lifestyle and your height as well. A more vigorous exercise routine will mean a higher calorie count is required to stay healthy. We all know that calorie restrictions are an excellent way to drop weight, but we open ourselves up to other health problems if we consume too few calories.

Weight gain is a common side effect of hormone therapy both for masculinizing and feminizing hormones. Although this side effect can be unwanted in some cases, others might need to gain some weight, either through building muscle mass or just simply because they are underweight and can benefit from an increased body fat percentage. Furthermore, trans women who are starting off their estradiol treatment should also be aware of the risk of diminished bone density.

There is much more to a healthy diet than a habit to count calories. We also need to mind the nutritious value of the foods we eat and how that impacts our overall health. There are several food groups that we need to be aware of and understand:

Protein

Protein is most often found in meat, fish, and eggs, but also in things like tofu, nuts, and seeds.

Protein is vital for a balanced and healthy diet. Increased protein intake is good for building muscle mass and managing weight because it helps control insulin levels.

Although high protein intake diets are pretty popular, we need to be aware that too much protein in your diet can damage your kidneys, so we urge caution in the consumption of protein shakes, etc. It is best to do these things in moderation and in combination with an appropriate diet plan and exercise routine. The goal of many transgender people, especially transgender men, is to build lean body mass, which is a good goal for your overall health. It is therefore essential to understand how lean body mass is built healthily.

Another consideration to make is if you are vegetarian or vegan. In such a case, you would already understand the importance of alternative protein sources. No matter the root you choose, it is essential to consume enough proteins in your diet without consuming so much that you damage your kidneys.

Fats

We have probably all heard of bad fats and good fats, but most people might not entirely understand the difference.

Monosaturated and polysaturated fats are often referred to as good fats, whereas trans fats are considered bad fats. Saturated fats fall in the middle of the two extremes.

Bad fats are natural fats that have been artificially manipulated. These are linked to insulin resistance, high cholesterol, and heart disease. Trans fats are very widely used, and although some countries have made laws against their use, it is still good to check ingredients and nutrition tables on products so that you can be sure to avoid trans fats as far as possible.

Saturated fats are usually animal fats. They are commonly found in whole fat milk, meats, margarine, etc. You can generally spot them by thinking of fat that is liquid when hot but solid when room temperature. This type of fat can have the same effect as bad fats, but it does take higher volumes of it to achieve the same impact.

Nonetheless, it is best to keep saturated fats to fewer than 10% of your daily calories. The consumption of saturated fats is contraindicated for losing weight but can be fine, in moderation, when a healthy weight has been reached.

Good fats can be found in fish, nuts, seeds, and vegetables. This type of fat is essential to your diet. Your body needs it to be healthy, but it cannot make it by itself. These fats are also necessary for hormone balance and coping with stress. It is essential to include them in your eating plan.

It is essential to understand that even though bad fats do not have more calories than good fats, they are considerably more harmful to your health.

Carbohydrates

Carbs are sugars and starches that the body converts to glucose. The more carbs you eat, the more you will struggle to lose weight, simply because your body likes to use glucose as energy instead of fat. So if you give it a lot of carbs, it will have a lot of glucose to use before it gets to the fat that you want it to burn.

Glucose is also dangerous if you are at risk of diabetes or insulin resistance. While it is not advised to cut it out completely, it should be consumed sparingly. It is also better to use whole grain varieties instead of highly processed varieties and to avoid foods with added sugars.

Nutrition and the Transgender Community

When you are struggling with gender identity, it is likely, although not guaranteed, that you would also experience some kind of body dysphoria. Unfortunately, research into the nutritional needs of transgender women and transgender men, as well as gender non-conforming individuals, is in its infancy.

So far, the one thing that researchers wholeheartedly agree on is that transgender individuals have unique nutritional needs, and these needs may vary significantly depending on where the trans person is in their transition. For this reason, if you are unsure about your diet, you might benefit from a consultation with a dietician or nutritionist who will be able to run some tests in order to help determine your ideal diet and your ideal body weight.

Nutrition for Transgender Women

A transgender woman is often taking estrogen as part of a hormone therapy regimen, and a potentially good source through which to balance hormones is through the consumption of phytoestrogens. There are some contradictory results in research, but most studies tend to show that the intake of phytoestrogens is associated with improved health.

A good source of phytoestrogens is soy and other beans, like edamame. Dried fruits and sesame seeds, garlic, wheat bran, and cruciferous vegetables are also rich in these hormones. We should mention here that while these foods can increase estrogen levels slightly, they do not tend to have any effect on testosterone levels.

In order to reduce testosterone levels, it is best to reduce the intake of meat, animal fat, and other cholesterol-related fats. It might be essential to remember that lower testosterone levels can often result in weight gain, so it might be a good idea to count your calories during your transition just to make sure that you are going in the right direction and not eating too much to maintain your weight, or to reach your goals. This is most applicable if you have recently started taking hormones. If you have been on them for a while, then your body will likely adjust.

Nutrition for Transgender Men

Fat produces estrogen.

Dairy and meat products could contain high levels of estrogen if not organic. There is some evidence to suggest that the Mediterranean diet, high fiber diets, or vegetarian/vegan diets are better to lower estrogen levels. Still, again, these are estimations, and the true long-term effects as well as effects specific to trans men have not been established.

Increased fiber intake, flaxseed, sulfur-rich foods, and organic foods can help maintain lower estradiol levels.

Hormones and Weight Fluctuation

Hormones can have a profound effect on your body. Not only does it play a part in fat distribution, but it also influences appetite and metabolism.

When we look at weight from a distance, then managing it seems really simple. To lose weight, you should be either:

• Burning more calories than you consume.
• Consuming fewer calories than you burn.

And the opposite would be true to gain weight.

However, in practice, this relies on a great many other factors, and there is often a substantial difference between achieving these goals in a healthy way or in a decidedly unhealthy way. So let's explore some healthy options for weight management.

How to Lose Weight Safely

As with the rest of the world, someone belonging to the transgender community might sometimes need to bring their weight down for a number of reasons. There is a good way to do this and a bad way. Extreme calorie restrictions and unhealthy eating habits can be a big problem. It can lead to eating disorders, and a bad diet can lead to other health conditions as well.

To begin with, drink lots of water. Water can help you feel fuller and can make it easier for your body to digest heavy foods. Next, try to drink some, but not too much, caffeine. Stimulants can reduce appetite. Focus your diet around whole foods instead of highly processed options. Also, try to count your calories so that you know where they are coming from and what kinds of adjustments you can make in order to keep your diet sustainable. Lastly, try not to drink your calories.

For example, many people think that substituting a meal with a smoothy is an excellent way to drop weight, but this is not always the case. Smoothies can be high in calories, and because they are so easy to digest, you tend to retain more of those calories than you might if you consumed them through solid foods.

Try to eat a lot of antioxidants, like blueberries and dark chocolate, in order to promote feelings of fullness. But do not overdo it.

How to Gain Weight Safely

People who are below their ideal weight may feel full faster. So a good place to start in gaining weight healthily is to eat more often during the day. Make sure that the food you are eating is highly nutritious. If you are finding it challenging to eat multiple extra meals a day, then try to drink some smoothies instead. They can often be high in calories, easy to digest, and a great alternative to eating solid food that can feel heavy and uncomfortable. Stay away from trans fats that can be bad for your health, and focus on foods that have healthy undertones.

While you are eating more food to gain weight, you still need to maintain exercise routines. However, the goal is not to burn fat but rather to build muscle for an MTF transition. However, if you are a trans woman, you might not want to build muscle. In this case, a high carb (whole grain carbs) can help to increase weight while still maintaining exercise.

Body Fat Requirements for Surgery

Lose Fat for Surgery (Body Mass Index Requirements)

Although there has been much debate about the objectivity of this practice, some countries will have body mass index requirements for surgery. This is one of those areas where the intention is good, but the execution is questionable at best.

While there is clear and undeniable evidence that higher levels of body fat increase the risks for surgical complications, there is also clear evidence that BMI is not universally applicable. While the medical community grapples with this dilemma (the need to minimize risks vs. the need to find reliable ways to measure those risks across the vast expanse of human diversity), they might still be using measures that are problematic.

Discuss weight and BMI requirements with your surgeon early on in the process so that you can be prepared should there be any such requirements that might delay surgical options for you. Your surgeon will likely be able to provide you with more accurate information on rules that they are required to follow as opposed to potentially outdated internet sources. They can also explain in more detail why these rules are essential, and you will likely find that most of the rules are well-intentioned, if not universally applicable.

Exercise

The general recommendation is 30 minutes of aerobics at least five days a week. This is standard for everyone and is usually recommended as a minimum.

If you are new to the life of monitored diet and exercise, it is essential that you not fall for fads but find exercise that you like doing. This is the only way to make changes sustainably.

Exercise has several benefits that are universal. It helps to reduce depression and anxiety; it can help loose, gain, other otherwise manage weight. It lowers the risk of blood clots and diet-related diseases like diabetes and cholesterol, and it can be highly beneficial to your self-esteem.

It is not only what you eat that matters, but also how your body is used to processing that food. Eating a diet rich in organic food and other healthy options will help with weight loss, but finding a diet that works best for you overall can be a little bit more complicated. A regular exercise routine can make this process considerably more manageable.

You will have more calories to spend on food that you like, and your diet can include more foods that can potentially help with your transition. Exercise can significantly improve your quality of life and will undoubtedly keep your doctor happy.

When you start hormone therapy, your doctor will likely explain that it is unlikely that your body weight will be left unchanged throughout your transition. For example, hormones will affect fat distribution in your body and will affect your ability to build muscle.