Disordered Eating in Transgender Youth

BY: Addie Humphrey

DATE: 7 March 2018

Eating disorders affect people of all genders and sexual orientations. However, people with certain identities experience higher rates of disordered eating than others.1 It is important that we talk about these differences, so we can better understand and support individuals at high risk of developing an eating disorder.

Research on the lesbian, gay, bisexual, and transgender (LGBT) population shows that this group is at heightened risk of disordered eating.1,2 LGB and transgender individuals (people whose gender identity does not match their sex assigned at birth) face similar stressors, such as stigma, that increase eating disorder risk.3,4 Other factors are unique to each group. For example, transgender individuals who experience gender dysphoria may engage in eating disorder behaviors, such as fasting or excessive exercise, in attempts to alter their body shape or size to achieve a desired physique.5

Most people in eating disorder research samples are cisgender (a person whose gender identity matches their sex assigned at birth), and even among LGBT studies, the number of transgender individuals included is often small.4 In fact, most studies still only allow binary responses for sex/gender questions, in which you can click “Male” or “Female.” Occasionally, respondents are given the option of clicking “Other” or “Prefer not to answer.” It is critical that transgender people are identified and represented in research so that we can understand how to best prevent and treat eating disorders in this vulnerable population.

Through a survey of 923 Canadian transgender youth, Watson and colleagues compared 14 – 18 year olds and 19 – 25 year olds across five disordered eating behaviors: binge eating, fasting, diet pill use, laxative use, and vomiting.4 The researchers also explored factors that may increase or decrease risk of disordered eating.

Main takeaways from the study:

  • Binge eating and fasting were highly prevalent, with 35 to 45% of individuals reporting each behavior.
  • Roughly half of the 14 – 18 year olds reported disordered eating in the last year: 42% reported binge eating, 48% fasted, 7% used diet pills, 5% used laxatives, and 18% vomited. Among the 19 – 25 year olds, almost a third reported disordered eating, with 29% reporting binge eating, 27% reporting fasting, 4% using diet pills, 3% using laxatives, and 5% vomiting.
  • Transgender youth frequently experience violence and harassment, which is often linked to gender-based stigma.6,7 Watson and colleagues call this “enacted stigma.” Youth who experienced more enacted stigma were at higher risk of binge eating, fasting, and vomiting.
  • Those with greater social connectedness and support were less likely to binge eat, fast, or vomit. For the 19 – 25 year olds, social support was negatively associated with vomiting. In 14 – 18 year olds, family connectedness, and to a lesser extent school connectedness and perception of friends as caring, were associated with lower risk of disordered eating.
  • Those with the lowest number of protective factors and the most enacted stigma experiences had the highest risk of disordered eating.

Transgender adolescents and young adults are at heightened risk for disordered eating.1,3,4 In a large population-based sample of U.S. college students, 15.82% of transgender students reported having a diagnosed eating disorder in the past year, compared to .55 to 3.52% of cisgender students.1 Clearly eating disorders are a serious concern for the transgender community, and it is important for parents, teachers, and clinicians to be aware of this. Those of us close to transgender people need to be familiar with the signs and symptoms of eating disorders. Families and schools should strive to create an environment that helps transgender youth feel connected to others and provides protection from enacted stigma. By offering our support and fighting back against stigma, we may help protect transgender youth from developing disordered eating and other mental health problems.



  1. Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health57(2), 144-149.
  2. Watson, R. J., Adjei, J., Saewyc, E., Homma, Y., & Goodenow, C. (2017). Trends and disparities in disordered eating among heterosexual and sexual minority adolescents. International Journal of Eating Disorders50(1), 22-31.
  3. Testa, R. J., Rider, G. N., Haug, N. A., & Balsam, K. F. (2017). Gender confirming medical interventions and eating disorder symptoms among transgender individuals. Health Psychology36(10), 927.
  4. Watson, R. J., Veale, J. F., & Saewyc, E. M. (2017). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders50(5), 515-522.
  5. Murray, S. B., Boon, E., & Touyz, S. W. (2013). Diverging eating psychopathology in transgendered eating disorder patients: A report of two cases. Eating Disorders21(1), 70-74.
  6. Kwon, P. (2013). Resilience in lesbian, gay, and bisexual individuals. Personality and Social Psychology Review17(4), 371-383.
  7. Saewyc, E., Konishi, C., Poon, C., & Smith, A. (2011). 2. Is it Safer to be Gay in High School Today? Trends in Sexual Orientation Identity and Harassment in Canada. Journal of Adolescent Health48(2), S8-S9.