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Transgender people face unique weight challenges

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In the 1990s, the idea of a transgender person was not a reality, and if it was portrayed in the mainstream it was made out to be odd or resembling some sort of circus act. Americans have come a long way as issues like being fired from a job or facing direct violence because you’re transgender have decreased immensely, but not totally. Transgender is a blanketed term for people whose gender identity is different from the gender they were thought to be at birth. When we’re born, the doctor looks at us and says we’re either male or female based on what our bodies look like. 

“Being transgender means different things to different people. Like a lot of other aspects of who people are, like race or religion, there's no one way to be transgender, and no one way for transgender people to look or feel about themselves. The best way to understand what being transgender is like is to talk with transgender people and listen to their stories,” says the The National Center for Transgender Equality. There’s a lot of information that’s circled around about those who are transgender, but there’s one thing we do know—there are unique weight issues that those who are transgender face with hormone treatment, gender reassignment surgery, and also the lack of insurance coverage or knowledge that takes place. So what are they?

1. Hormone therapy causing fat loss or gain.

Whether transgender male-to-female (MTF) or female-to-male (FTM), there’s going to be changes that take place depending on the hormone therapy—there’s dip in the testosterone and increase of estrogen for those who are MTF and vice versa. A 2016 study found that as estrogen therapy starts in MTF patients, they see increased body fat and breasts begin to develop. Along the same lines, researchers also found that body fat decreased and lean muscle formed in those FTM patients who began testosterone therapy. It’s important to be aware of the changes that happen to your body—but positive news—the study also discovered that those 70 patients who went through hormone therapy actually reported less stress 12 months after starting.

2. Inaccessible health care

Trans people may face the risk of not receiving healthcare not only because of lack of insurance coverage, but also because of the fear of being discriminated against. One in six LGBTQ participants said they’d faced healthcare discrimination one 2014 study of 577 people found. The estimate for those people who are trangender is actually much higher according to the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health. The other important piece here is that many insurance plans don’t cover hormone therapy or surgery so the chances of the expenses to first of all have surgery, and second, to complete follow-up visits are slim.

3. A decrease in physical activity

The motivation to get outdoors or go to the gym when suffering from body dysmorphia is slim to none. More studies definitely need to be done on transgender people over the age of 25, but one that offers great insight is a 2014 study at University of Minnesota School of Public Health. It combined 34,392 students surveys from 40 institutions to find that those participants who were transgender were way less likely to perform the recommended physical activity and spent more time on their phones. It’s important to focus on improvements in body functionality and mobility rather than hyperfocusing on shape or weight, especially while experiencing so many changes during transition.

A few important resources

We encourage you to talk with your medical provider about your desire to lose weight and monitor for weight-related conditions (e.g., insulin resistance) associated with hormone therapy. If you’re transgender, considering sex-reassignment surgery, have someone close to you who is, or just want to learn more.

GenderGP - join a community, read blog posts, and get answers to questions in leading transgender research.

American Bar Association - get to know legal rights, access to free help lines, and general information.

Trans Lifeline - a trans-led organization that connects trans people to the community, support, and resources.

Transgender Lives: Your Stories - The New York Times has compiled constantly evolving stories offering camaraderie and diversity in the trans community.

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  • Bostwick, W. B., Boyd, C. J., Hughes, T. L., West, B. T., & McCabe, S. E. (2014). Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. The American journal of orthopsychiatry, 84(1), 35–45.
  • Unger C. A. (2016). Hormone therapy for transgender patients. Translational andrology and urology, 5(6), 877–884.
  • Barrett, B. J, et al. (2020). Healthcare avoidance due to anticipated discrimination among transgender people: A call to create trans-affirmative environments. SSM Population Health, (11) 100608.
  • Casey, L. S., PhD. (2017). Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research. Special Issue: Experiences of Discrimination in America.
  • VanKim, N., A., et al. Weight-related disparities for transgender college students. Health Behav Policy Rev. 2014 March 1; 1(2): 161–171.

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