New research has shown that receiving cross-sex hormone therapy (CHT) can help to reduce the feelings of body dissatisfaction associated with eating disorders including anorexia and bulimia in transgender people.
The study was led by academics at the universities of Nottingham and Loughborough who recommend that clinicians working at eating disorder services should assess patients for gender identity issues and refer them to transgender health services to be evaluated for hormone treatment.
Professor Jon Arcelus, of the Institute of Mental Health, based at the University of Nottingham, and at the Nottingham Centre for Transgender Health, was one of the lead authors on the research, which has been published in the European Eating Disorders Review.
He said: “Young transgender people may restrict their food as a way to control their puberty, stop their period or reduce the development of breasts. Eating disorder professionals should consider the gender identity of the person when assessing a person with symptoms of an eating disorders.”
Eating disorders including anorexia, bingeing, self-induced vomiting and the misuse of diet pills and laxatives have been linked to people’s deep-seated unhappiness with their body, fuelled by Western society’s obsession with an idealised image of beauty.
This dissatisfaction in body shape and weight can be even more distressing for transgender people who identify with a different gender than the one assigned to them at birth, leaving them potentially more vulnerable to developing an eating disorder.
For some transgender people, striving to achieve a masculine or feminine body shape can influence their eating behaviours, while in the case of transgender males (assigned female at birth but who identify as male) who are not on hormone treatment some may even restrict what they eat as a way of stopping menstruation.
Within the non-trans population, negative emotions such as anxiety and depression and low self-esteem fuel the relationship between body dissatisfaction and problems with eating behaviours. As research has consistently shown that transgender people seeking gender affirming treatment who are not on hormone treatment yet, are much more likely to suffer with mental health problems such as anxiety and depression that cis gender (non transgender) people, this places them at greater risk of developing an eating disorder.
Evidence from one previous study showed that eating disorder symptoms were found to reduce in transgender women once they had progressed through their medical transition. However, the study was limited as it looked at a small number of participants, only at transgender women and only considered the role of surgery, not hormone therapy.
The latest research looked at more than 560 patients over the age of 17 who were recruited while attending an assessment at a national transgender health service in the UK between 2012 and 2015. Just under 25 per cent of the patients (139) had already started hormone treatment prior to the assessment, accessing the treatment through a range of avenues, for example, through private healthcare providers or the internet.
The patients were asked to provide information about their age, gender assigned at birth and whether they were on hormone treatment before being invited to complete a number of questionnaires on issues including eating-relate symptoms self-esteem, depression and anxiety and body dissatisfaction and perfectionism.
The data was analysed and results showed that the patients not on hormone treatment were significantly more likely to report their need to be thin, coupled with bulimic behaviours. This was also strongly connected to issues with body dissatisfaction, a preoccupation with perfectionism, experience of trust issues in personal relationships and depression and anxiety.
Professor Arcelus added: “These findings help to clarify the mechanisms through which hormone treatment might be able to improve eating disorder symptoms in this population. They suggest that hormones primarily improve body dissatisfaction, which in turn reduces levels of perfectionism and symptoms of anxiety, and increases self-esteem. In combination, these factors then appear to alleviate eating disorder symptoms.
“This is the first study with transgender people that has been able to indicate how cross-sex hormones alleviate eating disorder symptoms, although this finding needs to be replicated with more longitudinal research.”
The researchers believe that offering access to specialist transgender services is imperative as the results show that for many transgender people who are unhappy with their body, cross sex hormone treatment is very effective.
However, they say that further research is needed to include the increasing numbers of transgender people who identify outside the binary gender system, for example, gender neutral, non-gender, bigender and third gender.
The research was part of Beth Jones’ PhD co-supervised by Professor Jon Arcelus, Dr Emma Haycraft and Dr Walter Bouman.
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