Gender-affirming hormone therapy (HT) is just one of several facets of gender-affirming care that transgender people may turn to. It's important to nourish your physical, mental and emotional health when you make the decision to undergo hormone therapy — and nutrition is just one, but major, component of your wellbeing.
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Choosing to undergo gender-affirming HT is a big and possibly life-saving decision, and prioritizing your nutrition can help support your body as it changes.
What Is Gender-Affirming Hormone Therapy?
Gender-affirming hormone therapy is medicine that is prescribed to help a person align their physical characteristics with their gender identity, per Temple Health. And this medicine can take the form of pills, injections, patches or creams based on a person's health history and gender-affirmation goals.
There are two types of gender-affirming hormone therapies: feminizing and masculinizing.
During feminizing hormone therapy, trans women and transfeminine non-binary individuals (who are assigned male at birth) are placed on a regimen of testosterone blockers and given estrogen, per Temple Health. During masculinizing hormone therapy, trans men and transmasculine non-binary people (who are assigned female at birth) are given testosterone, which reduces estrogen levels.
There are major benefits to both types of hormone therapies, according to the Mayo Clinic, such as:
- Making gender dysphoria less severe (gender dysphoria is distress or discomfort caused when one's gender identity differs from the sex assigned at birth)
- Reducing psychological and emotional distress
- Improving psychological and social functioning
- Improving sexual satisfaction
- Improving the quality of life
Overall, the dietary needs of trans people who are starting gender-affirming hormone therapy aren't that different from anyone else's.
"There are no specific dietary recommendations for a trans person who is medically transitioning with HT," says Whitney Linsenmeyer, PhD, RD, spokesperson for the Academy of Nutrition and Dietetics, assistant professor and director of the undergraduate nutrition program at Saint Louis University. "The same Dietary Guidelines for Americans that we recommend for the general population still apply."
But that's not to say that food doesn't play a part in supporting you during your hormone therapy journey.
"Masculinizing or feminizing hormone therapy has known side effects where nutrition can play a supporting role," Linsenmeyer says.
"For example, masculinizing HT is associated with weight gain, increased muscle mass, decreased fat mass, increased LDL cholesterol and decreased HDL cholesterol. Feminizing HT is associated with weight gain, decreased muscle mass, increased fat mass and variable effects on cholesterol levels."
Nutrition can help with these side effects by mitigating changes in cholesterol levels or supporting increasing muscle mass, she says.
Food and Self-Care
Food and nutrition can also serve as a balm for your emotional wellbeing as you begin hormone therapy.
"In my own practice, I have seen trans folks use food and nutrition as self-care for their evolving bodies," Linsenmeyer says. "The decision to come out as trans and/or medically transition can be a stressful time in a person's life, but it can also be a very powerful motivator to make broader lifestyle changes (like with nutrition and exercise)."
Using nutrition as an opportunity for self-care might look like eating regularly throughout the day or having go-to quick meals for when cooking feels overwhelming.
The Best Foods to Eat to Support Your Whole Health
There's still a need for ample research on trans individuals' nutritional needs, but the limited existing research out there has shown a connection between nutrition and gender-affirming hormone therapy.
A September 2020 review in Clinical Nutrition ESPEN found that trans folks have unique nutrition needs that vary based on the type of gender-affirming hormone therapy they are undergoing and where they are in the process.
As you begin hormone therapy, it's important to focus on a well-rounded and nutrient-rich diet. "A diet rich in vegetables, fruits, whole grains, lean protein and dairy will provide adequate nutrition for most folks — unless they have a medical condition that warrants a specific diet," Linsenmeyer says.
Here are some specific types of foods that can help support your whole health when starting gender-affirming HT.
1. High-Fiber Foods
Both masculinizing and feminizing hormone therapy can affect your cholesterol levels, so it's important to eat high-fiber foods that can help keep those levels in a healthy range.
"A dietary pattern that emphasizes a variety of vegetables, fruits, lean protein and whole grains, with limited added sugars, saturated and trans fat, can support healthy blood cholesterol levels," Linsenmeyer says.
Foods that are high in fiber and unsaturated fats can help to increase "good" (HDL) cholesterol, per the Centers for Disease Control and Prevention (CDC). High-fiber foods include:
- Beans (black, pinto, lima)
- Vegetables (artichokes, broccoli, cauliflower)
- Fruits (apples, bananas, pears, berries, prunes)
- Whole grains (oatmeal, brown rice, wild rice)
- Whole-grain bread and breakfast cereals
Having more fiber in your diet does more than just support healthy cholesterol levels as you undergo hormone therapy. Eating more fiber also supports your health in the following ways, per the Mayo Clinic:
2. Foods High in Healthy Fats
Masculinizing hormone therapy, especially, can raise your LDL cholesterol, Linsenmeyer says.
Cholesterol levels are also linked to heart health. High cholesterol increases the risk of heart disease and stroke, per the American Heart Association (AHA). Eating healthy fats is always a good idea, but getting more of them in your diet while you're going through hormone therapy can help keep your cholesterol levels in check.
- Fatty fish like herring, salmon, sardines and trout
- Oils like olive and canola
3. Lean Protein Foods
If you're looking to build muscle mass while undergoing hormone therapy, eating protein-rich foods can help.
"A dietary pattern that provides adequate protein, including a mix of both plant- and animal-based sources (i.e. beans, nuts, poultry, eggs) can support gains in muscle mass, if that is the goal," Linsenmeyer says.
And even if building muscle isn't your goal, your overall health can still benefit from eating a good mix of proteins. Eating nutritious protein sources, like the ones below rather than red and processed meat, is linked to a lower risk for type 2 diabetes, heart disease, cancer and premature death, according to the Harvard T.H. Chan School of Public Health.
Try these protein-rich foods:
- Skinless poultry
- Nuts and seeds
- Soy products like tofu
- Beans, peas and lentils
For more information check out this nutrition guide for trans and gender-diverse individuals, created by Linsenmeyer and Jackie Price, RD, program assistant and culinary instructor for the Department of Nutrition and Dietetics at Saint Louis University.
- Temple Health: "Gender-Affirmation Hormone Therapy"
- Mayo Clinic: "Feminizing Hormone Therapy"
- Clinical Nutrition ESPEN: "Hormone therapy, health outcomes and the role of nutrition in transgender individuals: A scoping review"
- USDA: "Dietary Guidelines for Americans"
- CDC: "Preventing High Cholesterol"
- AHA: "What Is Cholesterol?"
- U.S. Department of Health and Human Services: "Heart-Healthy Foods: Shopping List"
- Harvard T.H. Chan School of Public Health: "Protein"
- USDA: "Protein Foods"
- Mayo Clinic: "Dietary fiber: Essential for a healthy diet"
- Academy of Nutrition and Dietetics: "Choose Healthy Fats"