Nutrition for the Transgender Community

Maria Bez is a registered Nutritional Therapist and Kinesiologist, the mother of a transgender son, and a health professional. Helping transgender people stay healthy or address specific physical or emotional symptoms through an MTF diet or an FTM diet and lifestyle is a subject very close to her heart.

Everyone can benefit physically from making healthy food choices, including those on an MTF or FTM diet. It doesn’t have to cost anything if you buy locally grown fruit and vegetables and it can help you feel good too.

Please note that we use terminology like AMAB (assigned male at birth), MtF (male-to-female), and trans-feminine interchangeably for understanding across all age groups, cultures, genders, and identities. For more information, check out our glossary of terms.

Benefits of proper FTM and MTF diet include:

• Achieving your ideal hormone balance
• Reducing body dysphoria
• Giving you a sense of control in life
• Addressing other health problems
• Improving how clothes look and fit
• Uplifting your mood, energy, and self-esteem
• Helping with sleep
• Reducing depression and anxiety

As a trans person on an MTF or FTM diet, you will have varied nutritional needs depending on which hormones you’re taking and what your overall health is like. Below I have outlined some general tips and considerations. These guidelines do not replace advice from a medical practitioner.

Let’s start with the basics: in general, our diets are made up of protein, carbohydrate and fat. The variation of these key elements determines how healthy our overall diet is. Too much in one direction or another can lead to an unbalanced, unhealthy diet. My healthy eating plate graphic outlines what proportion of fats, protein, etcetera you need.

Striking the Right Nutritional Balance in Your MTF or FTM Diet

Protein

Protein is found in meat, fish, nuts, seeds, tofu, eggs. No specific protein recommendations exist for transgender people. However, a slightly higher protein intake may be beneficial in the context of weight gain, if you are a transgender man who is also looking to build muscle. Protein is also useful if you are a transgender female trying to keep to a healthy weight because it helps control insulin which is also known as the ‘fat storage hormone’.

As a guide, I usually say to my clients that a piece of meat or fish the size of your palm is enough for a meal. For transgender men, I would urge caution in going to extremes and having too much protein – for example in protein shakes, to build muscle, as this can lead to kidney problems. My advice to those looking to bulk up is to have moderate amounts of protein and do weight bearing exercises.

Fat

Fats are an essential component in any healthy, balanced MTF or FTM diet. They can be divided into good and bad fats. Here we will focus on the good fats.

Hormones are made of fat, so it’s important to eat good fats to help with hormone development. Fat is also essential as it coats your nerve cells which helps you to cope with stress and stay emotionally balanced.

Good fats include avocado, olive oil, nuts, seeds, and oily fish. Be conscious of products that are marketed as being healthy. For example, did you know that ‘healthy spreads’ are grey in colour, before they are bleached by the manufacturer to look like butter! Who wants to eat that?! It’s best to consume food in its most natural form (i.e. a little butter spread on your toast is healthier than a grey mush)!

Saturated fats (bad fats) may lead to increased blood fats (triglyerides) and unhealthy cholesterol. Bad fats include items such as cheese as well as the processed fats found in deep fried food and crisps etc.

Carbohydrates

Carbohydrates are mainly sugars and starches that the body breaks down into glucose for energy. They include potatoes, rice, pasta, cereals, and sugars. These foods make it harder to lose fat, because your body uses these for energy before it uses fat.

Consuming an excessive amount of refined carbs will cause blood sugar to rise which can trigger fat storage rather than fat burning. It also triggers high cortisol which can make any feelings of anxiety worse. Once insulin and cortisol rise too high, they work to decrease testosterone.

Ideally, you should include carbohydrates in your MTF or FTM diet to help increase your energy levels, but try to choose healthier unrefined versions: e.g. wholegrain rice, pasta, wholemeal bread, cereals and starchy veg (potatoes, carrots, parsnips).

Other healthy food choices include unprocessed fruits, vegetables, whole grains, pulses, nuts, and seeds. Products that are high in animal fat should be avoided.

It is also important to ensure that you are having enough fibre through vegetables.

What Does a Healthy Eating Plate Look Like?

Please see my healthy eating plate diagram which outlines the ideal portions. Colourful vegetables are very important because they provide protective phytonutrients. Peppers, beetroot, carrots, tomatoes, squash have been shown to protect against diseases and aging.

Specific MTF and FTM Diet Guidelines for Transgender Individuals

Lowering Testosterone for Transgender Women

• Reduce meat but make sure you have protein from other sources like nuts, seeds, eggs
• Reduce cholesterol by cutting back on saturated fats, processed food, and deep-fried food (crisps, fish and chips)
• Increase soy from tofu, miso, soya sauce, edamame beans
• Eat organic food

Lowering Oestrogen for Transgender Men

• Increase fibre from vegetables
• Increase flaxseed
• Increase foods with sulphur: eggs, meat, fish, nuts, seeds
• Increase organic food
• Reduce caffeine
• Reduce processed food

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Should You Count Calories?

Calorie counting is not going to drive healthier eating. If you count calories and that’s it, you will think that an avocado and a doughnut are equal (an avocado has 250 calories and a jam doughnut has 252 calories). But they are not.

Avocados:

1. Are burned at a higher rate than other types of fats
2. Increase the rate at which fat is burned
3. Cause the body to burn more calories after eating
4. Reduce appetite and decrease the desire to eat after a meal.

A doughnut does none of the above!

I like to make a big frittata (effectively a thick omelet) using 10 eggs and loads of vegetables. I then keep it in the fridge and have a slice for breakfast, lunch, or dinner. It’s a quick way of getting something healthy into your diet and helps to control blood sugar. It can last up to four days in the fridge.

The Importance of Hydration

Water is vitally important to our health. It helps regulate our blood pressure, helps concentration and detoxification. Aim to drink between one and two litres of water throughout the day.

Alcohol can disrupt blood sugar levels and hormones and make depression worse. Always moderate alcohol and try to keep to less than seven units per week.

References:

1. Bedell, Sarah. (2014). The pros and cons of plant estrogens for menopause. The pros and cons of plant estrogens for menopause. 139 (10), Pages 225-236.
2. Gomes, S., Jacob, M., Rocha, C., Medeiros, M., Lyra, C., & Noro, L. (2021). Expanding the limits of sex: A systematic review concerning food and nutrition in transgender populations. Public Health Nutrition, 1-14. doi:10.1017/S1368980021001671
3. Linsenmeyer, W., Drallmeier, T. & Thomure, M. Towards gender-affirming nutrition assessment: a case series of adult transgender men with distinct nutrition considerations. Nutr J 19, 74 (2020).