Introduction
Eating disorders are complex mental health conditions that affect individuals across all genders and backgrounds. However, research has shown an increased incidence of eating disorders in gender incongruent individuals—those whose gender identity does not align with their assigned sex at birth. This article explores the intersection of eating disorders and gender-affirming care, shedding light on the unique challenges faced by this population and the importance of providing comprehensive support.

The Connection Between Gender Incongruence and Eating Disorders

• Diverse Experiences: Gender incongruent individuals face unique challenges related to their body image and gender dysphoria. Research suggests that some trans masculine individuals may restrict food as a means to control breast growth, hip shape, and menstruation, aiming for a more aligned appearance with their gender identity. Non-binary individuals might engage in weight control behaviors to achieve a more androgynous body shape that aligns with societal expectations. For trans feminine individuals, food restriction can be used to achieve a “thin effect” and reduce body mass, which can also alleviate gender dysphoria.
• Control Mechanism: Denied access to gender-affirming care, some gender incongruent individuals may resort to food restriction as a way to regain a sense of control over their bodies. The lack of access to gender-affirming treatments can lead to seeking control through alternative means, which can include disordered eating patterns.

The Role of Minority Stress and Discrimination

Experiences of oppression, discrimination, and abuse can contribute to poor self-esteem and mental health conditions, including anorexia and bulimia. Gender incongruent individuals often face heightened levels of minority stress due to societal prejudice, which can exacerbate their vulnerability to eating disorders.

Barriers to Care

• Lack of Understanding: Many gender incongruent individuals seeking help for eating disorders report being turned away because their healthcare practitioners do not understand gender dysphoria. This lack of awareness can hinder early intervention and appropriate treatment.
• Sequential Treatment: On the other hand, some individuals seeking gender affirmation may be denied care until their eating disorder is under control. This sequential approach can delay access to gender-affirming treatments, perpetuating distress and suffering.

The Importance of Gender-Affirming Care

• Holistic Approach: Individuals struggling with eating disorders and gender incongruence require a comprehensive and inclusive approach to their healthcare. Gender-affirming care encompasses not only mental health support but also physical changes that align with their gender identity.
• Mental Health and Self-Esteem: Gender-affirming care has been shown to reduce mental health problems, increase self-esteem, and foster a positive sense of self in gender incongruent individuals. When individuals receive the affirmation they need, they are less likely to resort to food control as a means of coping with dysphoria.

The impact of food restriction during transition

Food restriction can have a significant impact on the development of secondary sex characteristics during someone’s transition and this impact will vary depending on the specific gender-affirming goals and the gender identity of the individual.

Food restriction can slow down and hinder the development of secondary sex characteristics associated with femininity, such as breast development and the widening of hips, and equally so with the development of masculine characteristics such as increased muscle mass and bone structure.

Conclusion
Addressing the intersection of eating disorders and gender incongruence is crucial for providing appropriate care and support to this vulnerable population. Healthcare providers must be educated about the unique challenges faced by gender incongruent individuals and adopt a holistic approach that considers both their mental health and their gender-affirming needs. It is imperative that we break down the barriers that prevent individuals from accessing the care they need and deserve, ultimately promoting better mental and physical health outcomes for all.