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Watching for eating disorders in transgender teens

A Stanford study finds that more than half of transgender teenagers intentionally gain or lose weight to align their bodies with their gender identity.

More than half of transgender teenagers intentionally gain or lose weight to align their bodies with their gender identity, a Stanford study found.

The study, published recently in the Journal of Adolescent Health, began because caregivers at the pediatric and adolescent gender clinic at Stanford Children's Health saw worrisome patterns of weight manipulation among their patients.

"We had a sense when we met our patients that they were perhaps manipulating their weight to get the body image they wanted," said the study's senior author, Tandy Aye, MD, a pediatric endocrinologist who directs the clinic. "But no one had looked into it or asked 'How often does this happen?'"

The study's first author is Stanford adolescent medicine specialist Jonathan Avila, MD.

The team knew of instances when a teen transitioning from female to male lost weight to have a less-feminine body shape and to suppress menstruation, which is often distressing for transgender males. They had also seen individuals transitioning from male to female who gained weight to have a curvier body shape. Both types of weight manipulation -- weight gains and losses -- could have medical side effects. For instance, extreme weight loss endangers bone health, while weight gain can lead to pre-diabetes.

So Aye's team asked their patients to participate in a study of the issue. The researchers were surprised by what they found: Among 102 transgender teens, 63 percent said they had intentionally lost or gained weight to try to make their bodies more like that of their identified gender. Patients' likelihood of weight manipulation was not related to having a specific gender identity, nor to whether they were receiving hormone therapy to give them physical characteristics of their identified gender.

The team also asked study participants to complete a standard eating-disorder screening questionnaire to assess eating-disorder risk. Fifteen percent of the participants had scores that indicated increased eating disorder risk, compared to 1-3 percent of their non-transgender peers.

"The percentage of transgender teens using weight manipulation to address their body image is considerably higher than in the general population," Aye said.

Furthermore, the gap between the results of the screening questionnaire and the percent of the teens who actually manipulated their weight implies that the standard method of looking for eating disorders works poorly for this group.

General pediatricians and other caregivers who work with transgender youth should ask them if they are intentionally gaining or losing weight and recognize that weight manipulation may be a response to their struggle with body image and gender, Aye said.

The research is part of a larger push to make sure that physicians take a comprehensive view of their transgender patients' health.

"Now that more transgender kids and teens are being seen, we're realizing their health needs," Aye said. "It's important for us to take a multidisciplinary approach to treating the whole patient, one that goes beyond only providing hormone treatments."

Photo by Mason Masteka

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