While a person is assigned a sex at birth of male or female, a person’s gender identity refers to their inner sense of being male, female, both or possessing no gender at all. Gender expression refers to the outward appearance of gender demonstrated through name, pronouns, clothing, haircut, voice, and more.
Transgender people have a gender identity and/or gender expression that differs from their sex designated at birth. Some transgender people may seek to medically transition with hormone therapy, which is typically used to produce physical changes that help align their body with their gender identity.
Feminizing hormone therapy involves taking medicine to block the hormone testosterone, as well as taking the hormone estrogen. Masculinizing hormone therapy involves taking the hormone testosterone. Hormone therapy may be taken as injections, pills, gels, sprays or patches. Not all transgender people will choose to be on hormone therapy, but for those who do, the speed and magnitude of the changes will differ from person to person.
Physical changes with hormone therapy
Transitioning with hormone therapy is often referred to as a “second puberty” given the many physical changes that occur, such as changes in hair growth, skin oiliness, body size and shape and the sound of one’s voice. These are normal and expected effects, especially during the first few years. Weight gain is a common side effect of both masculinizing and feminizing hormone therapy due to changes in body composition and appetite — this could be a few pounds for some or much more for others.
Hormone therapy also affects body composition, or the amount of fat and muscle someone has. Masculinizing hormone therapy tends to increase muscle and decrease fat, while feminizing hormone therapy tends to have the opposite effect.
Body shape may also change with hormone therapy which, to some, is an important part of their gender expression. This is due to changes in where fat is located in the body. Masculinizing hormone therapy tends to decrease body fat in the hips and buttocks, while the reverse often occurs with feminizing hormone therapy.
Hormone therapy may also impact other aspects of health where nutrition can play an important role, such as cholesterol levels, blood pressure and bone mineral density.
Healthy eating guidelines
People undergoing hormone therapy may wonder if they should change their diet or if certain foods might affect hormone levels. They also may wonder if there are beneficial foods that can "kick-start" their transition.
The same healthy eating guidelines apply for cisgender (or non-transgender people) and transgender people alike. In other words, there is no special diet to follow when starting on hormone therapy, though calorie needs may change slightly. A healthy eating pattern can help ensure you are meeting your nutrient needs, promote overall health and well-being and reduce the risk of many chronic diseases. Food and nutrition can also be a form of self-care during a time of rapid physical and emotional changes.
The 2020-2025 Dietary Guidelines for Americans recommends choosing a healthy eating routine that includes:
- Vegetables with an emphasis on a colorful variety including dark green, red and orange; beans, peas and lentils; starchy; and other vegetables
- Fruits, especially whole fruit
- Grains, with at least half being whole grains
- A variety of protein foods, such as lean meats, poultry, eggs, and seafood, as well as plant-based proteins such as beans, peas, lentils, nuts, and seeds
- Low-fat or fat-free dairy such as milk, yogurt, and cheese or lactose-free versions of dairy products
The Dietary Guidelines for Americans also recommend limiting daily intakes of added sugars, saturated fat, sodium and alcohol.
How a RDN can help
There is no one-size-fits-all approach to nutrition and health. A registered dietitian nutritionist, or RDN, can help you plan balanced meals, manage a diet-related disease, and meet your nutrition goals. To find an RDN near you, use the Find a Nutrition Expert tool.
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