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Intact female rats show higher binge-like eating when estradiol levels low (i.e., diestrous) and lower binge-like eating when estradiol levels are high (i.e., estrous).72 Similarly, women show higher binge eating and emotional eating in post-ovulatory phases (midluteal and premenstrual) when estradiol action is low1 and lower binge/emotional eating in pre-ovulatory phases (follicular/ovulatory) when estradiol action is high, independent of BMI or negative affect.73–77 Furthermore, data indicate that ovarian hormones exert direct effects on dysregulated eating symptoms (e.g., emotional eating, binge eating)73–76, whereas cycle/hormone influences on body-related concerns (e.g, body dissatisfaction, weight preoccupation) have been less robust78–82 and occur indirectly, e.g., secondary to emotional/binge eating or mediated by other cycle-based changes (e.g., water retention; overestimation of body size).79,80,82Together, these data highlight ovarian hormones as sex-specific biological factors that can enhance eating pathology, particularly emotional/binge eating, in women. In contrast to the prenatal/perinatal organization (e.g., masculinizing and defeminizing effects) from testosterone, ovarian hormones are not elevated in prenatal/perinatal development and do not play a major role at this stage of life.54 Thus, our review of ovarian hormones focuses on their organizational and activational actions on eating pathology during puberty, young adulthood, and midlife (perimenopause/menopause), and we only cover within-sex effects in females given a general absence of male data. The natural testosterone exposure during prenatal/perinatal development in males appears to impact sex differences in eating pathology by reducing risk in males relative to females; however, between-person variation in levels of circulating sex steroids, during and after puberty, could exert sex-specific effects that impact individual variation in risk among males and females and further contribute to sex-based differentiation in risk. Indeed, sex steroids facilitate organizational (i.e., long-lasting, permanent changes) and activational (i.e., transient alterations) effects on the central nervous system (CNS) that are known to drive between-sex differences and within-sex variation in the development of several sex-differentiated phenotypes (e.g., aggression, food intake, body weight).16,33,37 Hormone-dependent organization begins during prenatal/perinatal development, ends with the refinement of the CNS during puberty, and alters CNS responsiveness to the activational effects of circulating hormones on behavioral outcomes during adolescence/adulthood.33,38,39 Notably, because steroid hormones exert some of their action via intracellular genomic signaling (e.g., activation/inhibition of target genes)33,37,39, they are one set of biological factors that could uniquely contribute to the observed developmental and qualitative sex-based differences in genetic effects on eating pathology described above.
Van Caenegem et al. reported unchanged waist and hip circumferences after one year of testosterone undecanoate HT . In contrast, in the Pelusi et al. cohort, when comparing three testosterone administrations, WC was one parameter that did not have a statistically significant increase . Similarly to their increase in BMI, significant increases were observed in waist circumference after six months of testoviron in the Berra et al. study . However, in two studies, the increase was significant 28,36, and studies reported no significance 45,50,51,52. Similar to the BMI, weight changes were compared between baseline and post-treatment periods 27,28,31,33,42,45,50,51,52. In addition, 71% of Borger et al.’s trans sample cohort showed evidence of at least one metabolic syndrome component, which included obesity/overweight . The TW sample was on HT for over six months; Sánchez Amador et al. mentioned that this high prevalence was derived from the body changes from HT .
Despite these limitations, the main strength of this review is that it relies on an innovative topic. Considering this wide variety, assessing potential associations between this wide range of therapies and nutrition status was challenging. However, this study uses a sample solely categorized with gender dysphoria, which is nowadays not considered the most adequate criteria for classifying members of this target group Considering this wide variety of HT, assessing potential associations between this wide range of therapies and nutrition status was challenging. While all studies were of acceptable quality, a high heterogeneity was seen, primarily in the reports of gender identity and the types of HT presented in the articles.
The characteristics of the males in our study have some similarities to the female AN population. Although most of the endocrinopathies improved by optimizing nutritional status in our cohort, hypogonadism did not. He was interviewed by psychiatry and endorsed concerns of "being fat," a "fear of gaining weight," and would purge up to 5 times daily. Although more common in females, an estimated 5 to 10% of affected patients are males. Anorexia nervosa (AN) is a serious psychiatric disorder characterized by abnormal eating behaviors, resulting in weight loss and increased mortality.
In feminizing transitions, the user may attempt to suppress their larger body frame or muscle by practicing a restrictive diet, which may lead to compensatory behaviors such as the use of laxatives or purging . According to this synthesis, both TM and TW had higher levels of ED symptomatology compared to non-trans individuals, with TM displaying higher levels compared to TW . Nagata et al. developed community norms for the ED examination in transgender individuals . This becomes a crucial point given the higher prevalence of ED in transgender communities and is further corroborated by previous research conducted on this topic 17,18,19,20. Seal et al. review of the literature focused on the impact of HT on cardiovascular diseases in trans and NB individuals . The insufficient level of knowledge and skills about transgender health among general health and nutrition professionals has also been reported as low 9,10. Due to these alterations, the current recommendations state that the nutrition guidelines for one’s biological sex should be used to meet energy and nutrient needs if HT has not started .
In other cases, lower to medium BMI values were also reported, partly related to restrictive eating behaviors. Nutritional status is perceived as a relevant factor when administering HT and seems to be influenced by this therapy. Transgender health is a new area in the field of nutrition, given the unique gender experience of this population, which may not follow the standard dietary and nutritional recommendations, as well as the specific nutritional concerns related to HT.
They can be caused by a wide variety of reasons, from cultural and social influences to biological factors, such as genetics and hormones. Afternoon saliva samples were assayed for testosterone using high-sensitive enzyme immunoassays. The current study examined this possibility.
Lastly, 15.8% of the transgender sample in the Diemer et al. study was diagnosed with an eating disorder in the past year at the time of the study . Over a third of participants in the Kirby and Linde questionnaire followed a restricted diet to lose weight, 31% engaged in binge eating over the past 12 months, and 50% were attempting to lose weight . Kirby and Linde (2020) assessed weight loss attempts, weight loss methods, and binge eating tendencies with the questions derived from the University’s College Student Health Survey . Food habits consisting of low vegetable, grain, and fruit intake and excessive diet in saturated fat due to high consumption of fast-food meals were reported in all three studies 29,37,40. The body fat mass increased as the treatment proceeded in the TW sample in Mueller et al.’s prospective study due to a shift from lean body mass (LBM) to fat mass .
The patients in this study have not followed-up, which limits our ability to determine if there has been additional improvement in symptoms or biochemical parameters. Although these interventions have not been studied in large-scale randomized controlled trials, preliminary data on small case studies seem promising and an area for further investigation (22). Over the past few years, novel psychological treatments have emerged in the field of eating disorders, such as cognition, behavioral, and emotion-based approaches, exposure and response prevention, motivation enhancement, and family and couple-based interventions (22). As with many other previously published studies on male AN, this is a small case series, and a larger dataset analyses would reveal more information. - http://172.236.250.154:3000/tesha51l66674
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