Disordered eating and eating disorders | Transgender, non-binary and gender diverse children

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This blog post is a part of the resource – Supporting Transgender, Non-binary and Gender diverse Children & Young People, created by Felicity St John and Felicity’s collaborator and fellow Master of Sexology student Lindsay SmithFelicity, during a placement with Sex Ed Rescue in 2024.

Felicity St John has a Master of Sexology (Professional) with Distinction and a Bachelor of Human Services – Child and Family Studies. She currently works for an NGO as a supervisor of four practitioners, coaching and case managing families facing complex challenges. Felicity also offers professional development and consultancy. Her professional interest areas are sex education, puberty, LGBTQI+ people, child development, transgender/non-binary/gender-diverse people, relationship coaching, family coaching, and parenting psychoeducation. Felicity has a passion for supporting people to step into their capacity. When she’s not working Felicity loves to laugh, play, be with loves ones, rock climb, SUP board, explore nature, read, write, hike, cycle, swim, and laze about like a cat. You can contact Felicity via email.

‘My eating disorder developed as a way of stunting my puberty.’
– Kai Schweizer

‘Eventually, I sort of checked out of my body; being present was too painful. My eating disorder was the only thing that made me feel like I had any control over my changing body. I spiralled deeper into my illness until it totally consumed my life. I was cold all the time. I didn’t have any energy. My grades started to drop. And in spite of all my efforts, puberty continued to creep up on me’.
– Kai Schweizer

‘Being able to affirm who we are, in whatever way feels right, can be an essential part of eating disorder recovery for trans people like me.’
– Kai Schweizer

‘For so many years, I’d been trying to masculinise my body through disordered eating. Testosterone therapy masculinised my body in a sustainable way that didn’t compromise my health. My shape changed. My voice dropped. The monthly periods stopped. Strangers started to call me sir. I could shower with my eyes open’.
– Kai Schweizer

My 11 year old pushes her food around her plate without eating much. I’ve also noticed that our laxatives are missing. She’s always been an avid eater until her breasts started growing. I’m worried, but I don’t know what to say.

Transgender people have higher rates of eating disorders when compared to their cisgender peers. 22.7% of young trans people in an Australian study had been previously diagnosed with an eating disorder. 

Puberty is a time when bodies rapidly develop. For some transgender/non-binary/gender-diverse (TGD) people, this may mean experiencing the ‘wrong puberty’. The body before their eyes may increasingly not align with their gender. There can be a sense of a loss of control. There can be distress. There can be a disconnection from the body. There can be confusion, particularly for children without a language around being transgender. Ideally, families have a language around what it means to be transgender before puberty so they can move towards timely support if their child is TGD.

Transmasculine and transfeminine youth and adults may seek to try and shape their bodies to look more like their gender and less like the sex they were assigned at birth. For trans boys and men, this is called masculinising. For trans girls and women, this is called feminising. Disordered eating behaviours and exercise are two ways transgender people may attempt to masculinise or feminise their bodies, depending on what outcome they desire. Non-binary people may also try to shape their bodies to fit their gender as well. This can include masculinising and/or feminising. Cisgender people also shape their bodies to be in line with their gender.

Trans boys may attempt to hold back puberty changes such as breast/chest development and menstruation by restricting dietary intake. Trans boys may also seek to build or tone muscle through exercise. For example, they are bulking up their shoulders. Trans girls may control intake to try to move closer to cultural ideals of women being thin. Trans girls may also seek to hold back puberty changes from happening, such as beard hair and changes to their voice.

Around two-thirds of transgender youth have engaged in disordered eating. Trans people report higher use of disordered eating behaviours such as restricting dietary intake, bingeing, use of laxatives, diet pills, extended fasting, purging, and unprescribed steroid use. Increased exercise is another way to shape the body to one’s gender.  

An eating disorder is present when a relevant medical practitioner has diagnosed the person as having an eating disorder by meeting the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder (OSFED), and avoidant/restrictive food intake disorder (ARFID).

Some factors can bump up the risk of disordered eating and eating disorders. 

Being discriminated against and harassed as a young transgender person has been associated with increased rates of disordered eating. Higher rates of stigma, social distress, decreased school safety, body dissatisfaction, gender dysphoria, self-criticism, and higher body mass index (BMI) were associated with a greater likelihood of disordered eating in transgender adolescents.

Eating disorder risk factors for transgender adolescents include not being able to access timely support for gender dysphoria, body dissatisfaction, suicidal ideation, deliberate self-injury, suicide attempts, and higher BMI.  

Protective factors from disordered eating for trans people include social support, connectedness with family, connectedness with school, stable relationships, self-compassion, and caring friends.

Access to gender-affirming medical care, puberty blockers, and hormonal affirmation can improve eating disorders. SOC 8 recommends the use of reversible puberty blockers from the Tanner stage two for both transgender boys and transgender girls, where this is wanted and appropriate for the young person. SOC 8 also talks about the use of oral contraceptive pills (progestins) to suppress menstruation.

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Resources

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References

  • Analysing Body Dissatisfaction and Gender Dysphoria in the Context of Minority Stress Among Transgender Adolescents by Brecht et al., 2024.
  • A Scoping Review of the Research Literature on Eating and Body Image for Transgender and Nonbinary Adults by Heiden-Rootes et al., 2023.
  • Body Dissatisfaction and Disordered Eating in Trans People: A Systemic Review of the Literature by Jones et al., 2016.
  • Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR by American Psychiatric Association 2022.
  • Eating Disorders and Disordered Eating Behaviours in the LGBT Population: A Review of the Literature by Parker & Harriger 2020.
  • Eating Disorders in Sexual and Gender Minority Adolescents by Nagata et al., 2024.
  • Emerging Evidence: A Systemic Literature Review of Disordered Eating Among Transgender and Nonbinary Youth by Campbell et al., 2023.
  • Gender, Sexuality & Eating Disorders by Kai Schweizer & Butterfly Foundation Australia.
  • How My Gender Transition Helped Me Recover From an Eating Disorder by Kai Schweizer.
  • In Depth With LGBTIQA+ Specialist Kai Schweizer by Butterfly Foundation Australia 2020.
  • Our Sexuality by Crooks, Baur, & Widman 2021.
  • Trans Pathways: The Mental Health Experiences and Care Pathways of Trans Young People – Summary of Results by Strauss et al., 2017.

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Felicity St John holds a Master of Sexology (Professional) with Distinction and a Bachelor of Human Services – Child and Family Studies. She supervises a team in an NGO, coaching and supporting families with complex needs, and offers professional development and consultancy. Her interests include sex education, puberty, LGBTQI+ inclusion, child development, and family coaching. Outside work, Felicity enjoys time with loved ones, outdoor adventures, and creative pursuits.
You can find Felicity at LinkedIn - https://www.linkedin.com/in/felicity-st-john-726365256/