








































PATIENT-CENTERED CARE COMMENTARY 

 

8 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 
 

Nutritional Considerations for Transgender Patients  
Mitchell Anderson, MS, AT, ATC* ;Emma Nye, DAT, LAT, ATC† 
*University of Toledo, Toledo, OH; †Grand View University, Des Moines, IA 
 

 
Key Phrases 
Emotional Wellness and Mental Health, Comorbidities 
 
Correspondence 
Dr. Emma Nye, Select Medical, Grand View University, 
3164 SW Arlan Lane, Ankeny IA, 50023. 
E-mail: enye@grandview.edu  
Twitter: @EANye15 
 
Submitted: November 11, 2020 Accepted: November 15, 
2021. 

 
Full Citation 
Anderson M, Nye E. Nutritional considerations for 
transgender patients. Clin Pract Athl Train. 2022;5(1): 8-11. 
https://doi.org/10.31622/2022/0005.01.2.      
 
 
COMMENTARY  

Athletic trainers (ATs) serve as a key resource 
regarding nutritional information for active 
patient populations. Both in traditional and 
emerging settings, the ATs role often includes 
educating patients on proper nutrition, both for 
enhancing sport performance and maintaining 
healthy lifestyles. According to the Commission on 
Accreditation of Athletic Training Education 
(CAATE) 2020 Standards, ATs must practice in 
collaboration with other health care and wellness 
professionals. One vital partnership among health 
care providers (HCPs) is that of ATs and nutrition 
professionals. Personalized nutrition, particularly 
in athletic populations, has been used by dieticians 
(RD) and nutritionists (unregulated nutrition 
specialist) in an effort to enhance performance 
and improve health outcomes.1 It is imperative for 
ATs to possess a level of knowledge to 
appropriately answer patient questions, provide 
guidance and recommendations, and collaborate 
with other professionals in this area. Recently, the 
Joint Position Statement by the American College 
of Sports Medicine, the Academy of Nutrition and 
Dietetics, and the Dietitians of Canada, 
highlighted the importance of developing 
nutritional interventions that take into 

consideration the uniqueness of each individual, to 
improve health outcomes.2 The recognition and 
knowledge about unique nutritional considerations 
for patients is crucial in sports medicine. More 
importantly, when treating patient in the LGBTQ+ 
community, ATs and HCPs need to be aware of 
the contributing factors that can influence nutrient 
absorption. Athletic trainers have a unique 
opportunity to be a resource for nutritional-
related concerns for this population, and 
specifically for those who identify as transgender. 
LGBTQ+  patients face disproportionately high 
levels of food insecurity, obesity, and disordered 
eating while also facing barriers to accessing 
affirming and knowledgeable healthcare 
providers.3 The purpose of this commentary is to 
provide awareness and inform ATs and other 
HCPs about the unique nutritional considerations 
for patients who identify as transgender. Further, 
the commentary will serve as a call to action for 
ATs and other HCPs to research and develop 
transgender specific nutritional recommendations 
as a mechanism to reduce health care disparities 
for this population.  

Transgender individuals are people whose 
gender identity and/or gender expression differs 
from what is typically associated with the sex they 
were assigned at birth.3 Patients who identify as 
transgender represent a growing and 
underserved population in the U.S., and the 
percentages of the general population that 
identify as transgender continue to increase.4 As 
such, HCPs must become aware of the specific 
needs of this population. An important piece of 
transgender health care is the role of nutritional 
interventions in relation to hormone therapy, 
mental health and wellness, and chronic illness.  

Historically, nutritional principles have been 
primarily focused on cisgender patients, those 
whose gender identity aligns with their assigned 

mailto:enye@grandview.edu
https://doi.org/10.31622/2022/0005.01.2


Nutritional Considerations for Transgender Patients 

 

9 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

 
 

sex at birth.3 As athletic training and other 
healthcare professions work towards providing 
patient-centered and culturally competent care, a 
foundational level of understanding in 
transgender health care is vital. As identities within 
athletic populations become more diverse, ATs 
must focus efforts on providing holistic healthcare, 
which may include developing nutritional 
guidelines 

HORMONE THERAPY  

In an effort to improve transgender individuals’ 
access to quality nutrition care, it is important to 
first understand conditions for which this 
population is most at risk. Oftentimes, those who 
identify as transgender will undergo hormone 
therapy, and are at risk for adverse effects.4 
Testosterone therapy for transgender males 
(Assigned Female at Birth) may lead to weight 
gain, decreased lean body mass, decrease in lipid 
mass, increased LDL cholesterol, decreased HDL 
cholesterol, and increase hemoglobin and 
hematocrit.4 Additionally, long-term effects of 
testosterone may significantly reduce or eliminate 
the menstrual cycle, impacting iron needs for that 
patient. For transgender females (Assigned Male 
at Birth), estrogen therapy may present with 
weight gain, an increase in HDL cholesterol, a 
decrease in LDL cholesterol, and increased bone 
mineral density.4,5 For transgender adolescents, 
hormone therapy may impact bone health, where 
supplementation with calcium and Vitamin D may 
be warrented.4 In order to reduce the impact of 
the negative side effects, ATs may intervene and 
collaborate with nutritionists and dieticians to 
implement nutritional interventions that best align 
with the patients’ needs. 

In patients taking testosterone therapy, we often 
see an increase in LDL cholesterol, a cessation of 
menstruation, weight gain, and increased blood 
viscosity13, which may require advising patients to 
limit saturated fats and address other fatty meals 
with alternatives to decrease LDLs.6 Due to the 
increase in hematocrit and hemoglobin, fluid 

retention may occur.7 Monitoring the intake and 
elimination of liquids may be important when 
advising appropriate hydration before, during, 
and after activity. Weight gain, another side 
effect of testosterone therapy, may be managed 
by understanding the demands of a patient’s 
activity and advising appropriate weight gain, 
loss, or maintenance strategies. Transgender 
patients may also have a decrease or cessation in 
menstruation, warranting a conversation 
regarding bone health imperative. Athletic 
trainers should encourage the increase in calcium 
and vitamin D with dairy-rich foods, adequate sun 
light, and if necessary, supplements among this 
population. For transgender patients prescribed 
estrogen therapy, weight gain, increases in HDL 
and decreases in LDL, increases in bone mineral 
density, as well as cardiovascular side effects are 
common concerns. In addition to monitoring and 
encouraging physical activity for patients on 
estrogen therapy, nutrition interventions can also 
be implemented into their specific treatment plan 
to reduce potential cardiovascular pathologies.  

 A key issue surrounding nutrition assessment of 
transgender people is that nearly all equations 
used by dieticians and nutritionists are gendered.8 
Calculating the appropriate amount of nutrients a 
transgender person needs is multifaceted, as 
oftentimes transgender people are taking 
hormones and have modified nutritional needs 
due to physiological changes, causing inaccuracies 
in estimating energy expenditure rates. The 
premise of nutritional needs being calculated 
solely on gender has also been explored by 
Rahman and Linsenmeyer.8 In their study, the 
authors note differences in gender-specific diet 
and nutrition related considerations have only 
compared cisgender heterosexual males vs 
cisgender heterosexual females.8 Furthermore, a 
study by Smalley, et al8, discussed significant 
variations in health risk behaviors within each 
subcategory of sexual orientation, which highlights 
the need for ATs and other HCPs to further 
explore the dietary needs of sexual minorities 



Nutritional Considerations for Transgender Patients 

 

10 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

 
 

rather than through group membership.8 
Historically, patients who are viewed in a minority 
group, or a category that is differentiated and 
often discriminated against, have negative health 
outcomes and face additional barriers to health 
care as compared to the majority, further 
suggesting the need to develop nutritional 
guidelines that are not limited by the confines of 
binary gender.  

MENTAL HEALTH AND WELLNESS  

Additional considerations for transgender patients 
should also focus on mental health and wellness, 
and the link between diet and more positive 
mental health outcomes.2 The etiology of eating 
disorders in the transgender population is not 
clearly delineated, as relationships among 
sexuality, gender identity, body image, and 
eating disorders are complex.8 According to the 
National Transgender Discrimination Survey, those 
who are transgender have an increased risk of 
eating disorders and an increased risk of abusing 
diet pills because of social norms.9 This increased 
prevalence affects transgender females 
disproportionately compared to transgender 
males, and is related to feeling the need to meet 
ideal body standards, emotional trauma from the 
process of accepting gender identity, and stress 
from social stigma and discrimination.10  

Research exists to suggest weight gain is a side 
effect in the transgender population in those 
individuals undergoing hormone therapy.8 Anti-
androgen and estrogen therapies cause an 
increase in body fat, and a decrease in muscle 
mass.8 Diemer et al10 demonstrated a higher rate 
of self-reported eating disorders, vomiting, use of 
diet pills, and use of laxatives among transgender 
college students compared with their cisgender 
counterparts. In addition, transgender individuals 
have high rates of binge eating, fasting, and 
vomiting for weight loss.10 Differences in health 
outcomes exist between transgender patients and 
their cisgender counterparts; however disparities 
between transgender women and transgender 

men propose unique considerations for 
individualized healthcare.11 These disparities, 
coupled with the knowledge gap regarding best 
practices surrounding caloric needs of 
transitioning individuals, lends to additional 
barriers for transgender individuals receiving 
individualized nutritional planning.10 

CHRONIC ILLNESS 

Patients who identify as transgender may be at 
increased risk of chronic illness, like HIV or 
Cardiovascular disease, which can impact their 
specific nutritional if their transition process 
includes the use or hormone therapies.12  Human 
Immunodeficiency Virus (HIV) and cardiovascular 
disease are two of the conditions most researched 
within the transgender population; however, other 
chronic illnesses impact the patients’ body, 
including type 2 diabetes, cancer, obesity, 
depression, asthma, chronic obstructive pulmonary 
disease, and chronic kidney disease.13 The 
literature suggests that transgender people may 
be at higher risk for cardiovascular disease due 
to exposure of oral ethinyl estradiol, a common 
hormone prescribed to transgender females.13  

A substantial amount of literature links dietary 
factors to increased risk of chronic disease.2,7,9-10 
Although this correlation is well documented, there 
is a gap in knowledge regarding the nutritional 
needs and interventions to decrease the risk of 
chronic disease, specifically in the transgender 
population. Healthcare providers should 
understand how these illnesses have the potential 
to affect patients who identify as transgender, 
and more research should be completed to 
evaluate what nutritional interventions can aid in 
the healing process of such diseases. 

A need exists for understanding physiological 
changes within the bodies of patients who identify 
as transgender. Understanding the impact of 
hormone therapy, mental health and wellness, and 
chronic disease are three main influencers to 
consider when educating and developing 



Nutritional Considerations for Transgender Patients 

 

11 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

 
 

individualized nutritional care for patients who 
identify as transgender. 

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9. Grant J, Mottet L, Tanis J, et al. National 
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https://doi.org/10.3389/fnut.2019.00008
https://doi.org/10.1249/MSS.0000000000000852
https://doi.org/10.1249/MSS.0000000000000852
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