What it means to provide gender-affirming care – Part 2

What is the role of the dietitian in treating gender-diverse youth?

The core role of the dietitian when treating gender-diverse youth is to provide nutrition interventions in conjunction with the management of gender-related needs. 

The difference between treating gender-diverse adolescents versus cisgender adolescents is that among gender-diverse adolescents disordered eating may be rooted to prevent or decrease the development of secondary sex characteristics [4]. When working with gender-diverse youth our role is to explore and recognize the cause and driver of the disordered eating behaviour. We can work with gender-diverse clients and use nutrition guidance  to support their physical transition if desired. Similarly, we prevent gatekeeping of gender needs for adolescents by ensuring that treating the eating disorder occurs while simultaneously addressing gender needs. Engaging the family in the acceptance of this combined approach to treatment is crucial.

 

How to foster inclusion?

Among gender-diverse youth, there are no growth charts that exist, limiting access to appropriate nutrition assessment accounting for the individual’s sex assigned at birth and gender identity [5]. Therefore, as dietitians, we recognize that in this population discussing previous weight history may be uncomfortable. Similarly, we recognize that the discussion of menstruation may be challenging for some clients. However, even if an individual assigned female at birth does not want to be pregnant or have children, regular menstruation is important for overall health. 

As dietitians, we can work together with a gender-affirming multi-disciplinary team to utilize gender-affirming interventions and hormone therapy to cease menstruation in gender diverse youth who don’t want to menstruate and feel distressed by this. Furthermore, we recognize that this may be an important part of the medically necessary treatment to alleviate gender dysphoria [5].

How does hormone replacement impact natural body weight?

It is important to note that natural weight gain or loss is expected and common in hormone therapy. The expected onset is in the first approximate 3-6 months with a duration of 2-5 years [6]. Masculinizing hormone therapy involves testosterone or other androgenic steroids. Transgender people on testosterone therapy may experience a redistribution and/or reduction of body fat, and increased lean body mass, coupled with possible weight gain or loss. While feminizing hormone therapy involves estrogen and testosterone blockers. Transgender people on estrogen therapy and testosterone-blocker therapies may experience a redistribution and/or increase in body fat, a decrease in lean body mass coupled with potential weight gain or loss. It is important to not engage in diet culture activities that focus on fad diets and short-term changes. To learn more, check out our previous blog post on the Anti-Diet Approach. It is important to remember that weight is not representative of one’s overall health and being healthy and feeling good can occur at any weight. 

 

Why Sööma is an inclusive space?

Sööma is an inclusive space and aims to provide gender-affirming care. We understand that honouring the client’s gender identity is critical for the therapeutic relationship.  We never assume gender, and always ask our clients about gender identity and pronouns. We support clients in transition and complicated feelings about their bodies that may arise before, during and after. To create a safe and inclusive environment we have gender-neutral restrooms with clear signage at our Plateau Mont-Royal location. At Sööma we aim to educate our clients about internalized beauty standards and address any internalized transphobia explaining they are not “wrong” or “bad” for not fitting into the gender binary.

 

What are future directions and research needed to support this population?

Currently, clinical standards to guide nutrition care for gender-diverse patients are extremely limited. This is a limitation to providing nutrition care because many assessments are sex-specific and require practitioners to use either male or female sex which is limiting [7]. This could affect our ability to track growth in gender-diverse children and adolescents as well as estimate their energy needs [7]. Of importance to those with eating disorders include the interpretation of bone mineral density scans which rely on comparing an individual’s bone mineral density to an average of same-sex values. This results in interpretation challenges for clinicians providing gender-affirming care.  As such, future research and concrete guidelines are necessary to inform gender-affirming nutrition care [8]. 

 
 

Located in Montreal and looking for future resources?

To meet with a dietitian to discuss gender dysphoria and eating disorders please reach out to our team at info@sooma.ca or 514-437-4260. If you’re located in Montreal, GRS provides gender-affirming surgeries and their website has helpful resources and FAQs. If you are looking for short-term psychotherapy, you can consider the McGill Sexual Identity Centre as a resource. If you’re looking for support, and or advocacy opportunities check out Concordia’s Centre for Gender Advocacy.

 

Written by

Aviva Rappaport

Registered Dietitian

References

  1. Coelho JS, Suen J, Clark BA, Marshall SK, Geller J, Lam PY: Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Curr Psychiatry Rep 2019, 21:107.
  2. Rahman R, Linsenmeyer WR: Caring for Transgender Patients and Clients: Nutrition-Related Clinical and Psychosocial Considerations. J Acad Nutr Diet 2019, 119:727-732.
  3. Provincial Health Services Authority: Gender-affirming Care for Trans, Two-Spirit, and Gender Diverse Patients in BC. In A Primary Care Toolkit: Trans Care BC; 2021.
  4. Linsenmeyer W, Rahman R: Caring for Transgender and Gender Diverse Patients. In Special Edition Spring 2021. Future Directions in Clinical Nutrition Practice2021.
  5. Linsenmeyer W, Garwood S, Waters J: An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients. J Acad Nutr Diet 2022, 122:1081-1086.

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