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Diet and exercise for transgender people

by Andrea James Reviewed November 5, 2026 16 min read

You can have better health before, during, or after a gender transition. It is always the right time to do it. It does not have to cost anything, and it can help your transition go well:

  • Reduce body images issues
  • Give you a sense of control in life
  • Help you meet requirements for medical transition options
  • Improve other health problems
  • Improve how clothes look and fit
  • Improve mood, energy, and self-esteem
  • Help with sleep
  • Reduce depression and anxiety
  • Help you save money

A note on struggles with eating

If your relationship with food, eating, or exercise feels difficult right now, you are not alone, and it is not your fault. Many trans and gender diverse people experience these struggles at some point. Body image issues, the stress of discrimination, and the wish to feel more at home in your body can all shape how we eat and move, sometimes in ways that start to hurt more than they help. These struggles can look like restricting food, eating past fullness, purging, or exercising in a way that feels compulsive, and they can affect people of every size, gender, and stage of transition. Recovery is possible, and you deserve support that respects who you are. Many people find that gender-affirming care, a trusted clinician, and a community that understands them make healing easier. Reaching out is a sign of strength, and the resources below can help you take that first step whenever you are ready:

Medical requirements

Some people in our community have criticized what they call medical fatphobia:

Being fat is one such factor that can lower your prospects of medically transitioning. Although known to be inaccurate, particularly for people of colour, Body Mass Index (BMI) is used across [the UK’s National Health Service] and private medical services to determine eligibility for life-changing surgeries. Since the metric can be the deciding factor for access to top surgery or genital operations, you’d expect it to be applied consistently across health services. But contradictory application of BMI requirements is commonplace.

Some healthcare providers might make you have a body mass index (BMI) within healthy weight in order to get hormones or surgery. That is why you should know your BMI. Adults are measured differently than children and teens. Via the US CDC:

BMI has four adult categories:

Below 18.5Underweight
18.5 – 24.9Healthy Weight
25.0 – 29.9Overweight
30.0 and AboveObese

Some healthcare providers may also check your Charlson Comorbidity Index. This checklist takes your age and diagnosed medical issues, then finds out the chances that you will die in the next ten years.

If you are unwilling or unable to meet BMI requirements, you still have many options. Health at Every Size (HAES) activist Ragen Chastain has extensive information and resources about BMI-based surgery denials for trans and gender diverse people.

Hormones and weight change

Among people in our community who choose to use hormones, hormone use can cause changes in:

  • weight
  • body mass
  • fat distribution
  • height (adolescents only)
  • appetite
  • metabolism
  • motivation to exercise

Any or all of these changes can affect how your body appears to yourself and others.

Studies by Maartje Klaver indicate that cross-sex hormone use in transgender people can affect total body weight, body fat, and lean body mass. Klaver’s study found these group average changes:

  • trans women
    • +4 pounds (+1.8 kg) for body weight
    • +6.6 pounds (+3.0 kg) for body fat
    • -5.3 pounds (-2.4 kg) for lean body mass
  • trans men
    • +3.8 pounds (+1.7 kg) for body weight
    • -5.7 pounds (-2.6 kg) for body fat
    • +8.6 pounds (+3.9 kg) for lean body mass

Longer-term studies show these changes vary. In a US study following 470 people for up to five years, trans men gained weight within months of starting testosterone, while trans women’s weight stayed stable for about two years before rising (Kyinn et al., 2021). Another found BMI rose in trans women but not trans men (Suppakitjanusant et al., 2020). Hormones also shift where fat is stored: on average, trans women gain fat in the hips and thighs, while trans men lose fat there (Klaver et al., 2018).

Diet

Body weight depends on energy balance (the relationship between the calories you take in and the calories your body uses):

  • Eating fewer calories than you use leads to weight loss over time.
  • Eating more calories than you use leads to weight gain over time.

You may have heard that 1 pound equals 3,500 calories (or 1 kilogram equals 7,700 calories), so cutting 500 calories a day should mean losing a pound a week. That’s a reasonable rough estimate for the first few weeks, but it overestimates what happens over months. As you lose weight, your body adapts:

  • A smaller body uses fewer calories, so the same eating habits produce less loss over time.
  • Your metabolism can slow by more than weight loss alone would predict, an effect called metabolic adaptation.
  • Hunger hormones shift, which can make you feel hungrier than before.

These changes are why weight loss usually slows and often stalls, and why most people regain some weight after dieting. Regain is not a personal failure or a lack of willpower. It’s your body working to protect its energy stores. For a more realistic estimate than the 3,500-calorie rule, try the Body Weight Planner by the National Institutes of Health, which accounts for these changes.

Hormone therapy can also affect appetite, muscle mass and where your body stores fat, so your weight may change even if your habits stay the same. That’s normal, and it’s worth discussing with your care team.

Because of all this, the most sustainable approach is to focus on habits you can keep long term, like regular meals, foods you enjoy, movement you like and good sleep, rather than on a number on the scale. Many health benefits, including better blood pressure, blood sugar, mood and energy, come from these habits whether or not your weight changes much.

Here are some tips which show that they can work:

Drink lots of water, including a big glass before meals.

  • I drink tap water that I filter with a Brita. If that tastes too plain, you can add low calorie flavorings or carbonation.

Drink a caffeinated beverage

  • Stimulants lower your appetite. Do not add dairy and sugar to your coffee or tea, or try to use less.

Do not drink calories

  • Fruit juices and sugary soft drinks are full of calories that can be changed for other things. Beer, wine, alcohol, and mixers have lots of calories, too, and they are often drunk while eating foods that are not good for you.

Shop along the walls of the grocery store

  • Produce, meats, dairy, and freshly baked goods made in the store are better than processed stuff in the middle aisles. Packaged foods like ramen or mac and cheese seem cheap, but they often have tons of carbohydrates and fat and salt.

Do not eat fast food

  • It is easy to find, and it seems cheap, but it is not a good choice. As an example, a Big Mac, large fries, and large Coke come to 1,340 calories. That is about the same calories as a 10-inch Domino’s pizza or a Chipotle chicken burrito with cheese and guacamole. You would have to walk for 5 or 6 hours that day to burn just one of those meals off.

Plan your meals

  • Restaurant food is expensive, often not very good for you, and the choice of people who do not plan well. Pack a lunch, plan your dinners and breakfasts. You can make a lot of things ahead of time so they are ready more quickly. Going out once in a while is a nice treat, but having people over is almost always cheaper and healthier.

Cook at home

  • Even if you do not have a stove, you can make healthy hot meals at home with a microwave, hot plate, slow cooker, countertop grill or griddle, rice cooker, air fryer, or toaster oven.

Do not use vending machines

  • Most food vending machines do not offer healthy choices, and they cost a lot for what you get.

Trade out candy and salty snacks

  • Replace them with fruits, vegetables, and healthier choices.

Consider fermented foods

  • I am a strong believer in vinegar and fermented foods like kimchi and sauerkraut and yogurt. They have low calories, and the fermentation is good for cutting cravings and helping digestion. My favorite is apple cider vinegar with “the mother.” I also love pickles.

Carbohydrates and fats

One common method of gaining or losing weight is by increasing or decreasing the amount of fat or carbohydrates in your diet. A 2018 randomized clinical trial found that low-fat and low-carb diets produced similar weight loss over a year.

Fats

Fat is an essential part of a nutritious diet. Fat is found in many foods:

  • Avocados
  • Olives and olive oil
  • Nuts like almonds, walnuts, and macadamias
  • Peanut butter and other nut butters
  • Seeds like chia, flax, and pumpkin
  • Fatty fish like salmon, sardines, and mackerel
  • Eggs
  • Full-fat Greek yogurt
  • Cheese
  • Whole milk
  • Tofu and tempeh
  • Dark chocolate
  • Coconut and coconut milk
  • Avocado and canola oil

Note that eating fat doesn’t affect where your body stores fat. Fat redistribution is driven by hormones.

Carbohydrates

Carbohydrates (also called carbs) are found in many foods:

  • Bread
  • Grains like rice
  • Starchy vegetables like corn and potatoes
  • Pasta
  • Cereal
  • Beer
  • Sweetened yogurt
  • Fruit juice
  • Low-fat salad dressings
  • Beans and legumes
  • Honey and sugar
  • Chips and crackers
  • Milk
  • Gluten-free baked goods

Reducing something in your diet helps you be more mindful about what you eat. When I want to lose weight, I stop having bread, pasta, potatoes, alcohol, and rice.

Count calories

  • Most people do not think much about what they eat.
  • If you keep track of everything you eat for a couple of weeks, you will start to see ways you can lower your calories. Use a calorie calculator for everything. When you see how much exercise you need to burn what you eat, you will start to think twice about a lot of food choices. These sites all give nutrition information for common foods:
    • Calorie King (calorieking.com)
    • MyFitnessPal (myfitnesspal.com) – also an app
    • Use Google to search any food item and a nutrition box will come up
    • Apps like SparkPeople, MyNetDiary, and Calorie Counter by FatSecret

Treat yourself now and then

  • Set a goal, and when you reach it, allow yourself a cheat day where you have something you love. For me, it is usually pizza, or chocolate, or wine. Sometimes I will go out with friends. The key is finding a good balance with treats so they really feel special.

Foods

Some foods may have a small effect on hormone levels in some people, but there is very little (if any) clinical evidence for these claims.

May lower testosterone (speculative, not backed by data)

  • Reduce meat
  • Reduce cholesterol
  • Reduce fat
  • Increase soy

May lower estrogen (speculative, not backed by data)

  • Increase fiber
  • Increase flax seed
  • Increase foods with sulfur
  • Reduce caffeine
  • Reduce processed food

Exercise

The US Centers for Disease Control and Prevention recommend getting 30 minutes of aerobic exercise 5 days a week.

Your body uses energy all day, even at rest. Most of the calories you burn go toward basic functions like breathing, circulation, and keeping your organs working, often called your resting metabolic rate. A smaller share goes to digesting food, and the rest to movement, from everyday activity like walking and chores to planned exercise.

How many calories you use depends on your age, body size, muscle mass, hormones, genetics, and activity level, so two people of the same weight can have quite different needs. Online calculators can give a rough estimate, but treat it as a starting point rather than a precise number.

Exercise burns calories, but on its own it usually leads to less weight loss than the math suggests. The body tends to compensate, partly through increased appetite and partly by spending less energy in other ways. Combining moderate changes in eating with regular activity tends to work better than either alone, and activity is especially helpful for keeping weight off once you’ve lost it.

Most importantly, movement has benefits that have nothing to do with a number on a scale. Regular activity improves heart health, blood sugar, sleep, mood and strength, and strength training can help shape your body in ways that may ease dysphoria. Choose activities you enjoy and can keep doing; consistency matters far more than intensity.

Find out rough estimates of how much various activities burn from calculators like these:

ACE Fitness (acefitness.org)

Harvard (health.harvard.edu)

Certain kinds of exercise can also change your body shape. Transmasculine folks often want to bulk up their upper bodies, and transfeminine people often want to bulk up their lower bodies. See the For us, by us section below for some exercise tips from other trans people.

Finding help when needed

Many people are able to manage their weight on their own through diet and exercise, but there’s also lots of help available! Skip the fads and gimmicks. They are like “get rich quick” schemes that prey on people who want an easy solution.

People with body image issues often have an unhealthy relationship with food and weight. Many people who are not able to express their gender may express those issues in the ways they eat, exercise, and appear. Gaining or losing unhealthy amounts of weight can sometimes happen before, during, or after transition.

Here are some ways to get help if you don’t feel you can do it on your own.

Friends and family

  • Maybe you and others you know can set goals together and give each other encouragement.

Support groups and meal plans

Clinical options

  • Most hospitals have dieticians, nutritionists, and weight loss clinics. Insurance policies and tax-funded public health programs have many options for those who need a healthcare professional, so check with your healthcare provider.

Prescription drugs

Skip over-the-counter drugs and home remedies. They are often just stimulants. Prescription drugs are sometimes an option for those who have been unable to meet their healthy weight goals with other options. Please note that prescription weight loss drugs do not have extensive long-term data on unwanted side effects.

Approved by FDA for weight management:

  • semaglutide (Wegovy), injected and oral
  • tirzepatide (Zepbound)
  • liraglutide (Saxenda)
  • bupropion-naltrexone (Contrave)
  • phentermine-topiramate (Qsymia)
  • orlistat (Xenical; lower-dose Alli is over the counter)

Same or similar drugs approved for type 2 diabetes, sometimes prescribed off-label:

  • semaglutide (Ozempic, Rybelsus)
  • tirzepatide (Mounjaro)
  • liraglutide (Victoza)
  • dulaglutide (Trulicity)
  • exenatide (Byetta, Bydureon)

Surgery

  • Surgery is a last resort.
  • Liposuction and fat freezing techniques can have complications and can only do so much before there’s a lot of loose skin in an area.
  • Bariatric surgery changes the size of the stomach. Most surgeons will only perform this on obese or morbidly obese people whose BMI is above 35. In some cases, they will do it for obese people with BMI of 30 and doing it will also help with some other health condition. These surgeries require a lifestyle change afterwards.

References

Kyinn, M., Banks, K., Leemaqz, S. Y., Sarkodie, E., Goldstein, D., & Irwig, M. S. (2021). Weight gain and obesity rates in transgender and gender-diverse adults before and during hormone therapy. International Journal of Obesity, 45(12), 2562–2569. https://doi.org/10.1038/s41366-021-00935-x

Beth Israel Deaconess Medical Center. (2021, August). Longest study of its kind reveals how gender-affirming hormone therapies impact obesity among U.S. transgender individuals [Press release]. EurekAlert! https://www.eurekalert.org/news-releases/925971

Suppakitjanusant, P., Ji, Y., Stevenson, M. O., Chantrapanichkul, P., Sineath, R. C., Goodman, M., Alvarez, J. A., & Tangpricha, V. (2020). Effects of gender affirming hormone therapy on body mass index in transgender individuals: A longitudinal cohort study. Journal of Clinical & Translational Endocrinology, 21, 100230. https://doi.org/10.1016/j.jcte.2020.100230

Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J. P. A., Desai, M., & King, A. C. (2018). Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion. JAMA, 319(7), 667. https://doi.org/10.1001/jama.2018.0245

Klaver, M., de Blok, C. J. M., Wiepjes, C. M., Nota, N. M., Dekker, M. J. H. J., de Mutsert, R., Schreiner, T., Fisher, A. D., T’Sjoen, G., & den Heijer, M. (2018). Changes in regional body fat, lean body mass and body shape in trans persons using cross-sex hormonal therapy: Results from a multicenter prospective study. European Journal of Endocrinology, 178(2), 163–171. https://doi.org/10.1530/EJE-17-0496

Linsenmeyer WR, Rahman R (2017). Diet and nutritional considerations for a FtM transgender male: A case report. Journal of American College Health Volume 66, 2018 – Issue 7 https://doi.org/10.1080/07448481.2018.1431917

Klaver, M., Dekker, M. J. H. J., de Mutsert, R., Twisk, J. W. R., & den Heijer, M. (2017). Cross-sex hormone therapy in transgender persons affects total body weight, body fat and lean body mass: A meta-analysis. Andrologia, 49(5), e12660. https://doi.org/10.1111/and.12660

Schaffer, R. (2017, December 5). Cross-sex HT induces sex-specific changes in android, gynoid regions. Healio. https://www.healio.com/news/endocrinology/20171205/crosssex-ht-induces-sexspecific-changes-in-android-gynoid-regions

Klaver M, Dekker MJHJ, de Mutsert R, Twisk JWR, den Heijer M (2016). Cross-sex hormone therapy in transgender persons affects total body weight, body fat and lean body mass: a meta-analysis. Andrologia, 2017 Jun;49(5). https://doi.org/10.1111/and.12660

Fothergill, E., Guo, J., Howard, L., Kerns, J. C., Knuth, N. D., Brychta, R., Chen, K. Y., Skarulis, M. C., Walter, M., Walter, P. J., & Hall, K. D. (2016). Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity, 24(8), 1612–1619. https://doi.org/10.1002/oby.21538

Klaver M, Vlot M, Dekker M, Megens J, den Heijer M (2015). The effects of cross-sex hormone therapy on body weight and fat percentage in transgender individuals. Endocrine Abstracts 37 GP13.05 https://doi.org/10.1530/endoabs.37.GP.13.05

Hall, K. D., Sacks, G., Chandramohan, D., Chow, C. C., Wang, Y. C., Gortmaker, S. L., & Swinburn, B. A. (2011). Quantification of the effect of energy imbalance on bodyweight. The Lancet, 378(9793), 826–837. https://doi.org/10.1016/S0140-6736(11)60812-X

Rosenbaum, M., & Leibel, R. L. (2010). Adaptive thermogenesis in humans. International Journal of Obesity, 34(Suppl 1), S47–S55. https://doi.org/10.1038/ijo.2010.184

Resources

This is health talk, not advice. Talk with your doctor before starting any new diet or exercise program.

Centers for Disease Control and Prevention (cdc.gov)

National Institute of Diabetes and Digestive and Kidney Diseases (niddk.nih.gov)

MDCalc (mdcalc.com)

Dietary Guidelines for Americans (dietaryguidelines.gov)

My Plate (choosemyplate.gov)

  • By the US Department of Agriculture

Obesity Medicine Association (obesitymedicine.org)

Drugs.com (drugs.com)

Bespoke Unit (bespokeunit.com)

Eating Disorder Hope (eatingdisorderhope.com)

  • Founded in 2005; a great resource.

Diet.com (diet.com)

  • Lots of useful meal plans at various calorie amounts.

Weight and Healthcare (weightandhealthcare.substack.com)

For us, by us

All Gender Nutrition (allgendernutrition.com)

  • Resources from dietiician Vaughn Darst

Gender Expansive Nutrition (genderexpansivenutrition.com)

  • Resources from dietician Taylor Craven

Pando Wellness (pandowellness.org)

  • Resources by dietician H. Coakley

Sean Bugg (youtube.com/@seanbugg)

Tommy Murrell (instagram.com/tommy_j_murrell_)

  • Trauma-informed weight lifting coach

Kyle Krieger (youtube.com/@KyleKrieger)

  • Laith Ashley talked about his workout
  • youtube.com/watch?v=NV96jnkd4ZA

Trans & Fit (youtube.com/@transandfit)

  • Motivational YouTube channel by Alex, active 2015-2016

Wussy (wussymag.com)

  • Body feminization workouts for trans-women and femmes
  • Part 1
  • https://www.wussymag.com/all/body-feminization-workouts-for-trans-women-and-femmes
  • Part 2
  • https://www.wussymag.com/all/body-feminizing-workouts-for-trans-women-and-femmes-part-2

Historic resources

FEDUP (transfolxfightingeds.org) [archive]

  • formerly Trans Folx Fighting Eating Disorders

River Eastwood (riverrunswild.com) [archive]

Laith Ashley (laithashley.com) [archive]

Trans Out Loud (transoutloud.com) [archive]

Alayna June (instagram.com/alaynajune96) [deleted]

Andrian Aliazas (youtube.com/@AndrianAliazas) [exercise content removed]

Transgender Fitness Life (transgenderfitlife.com) [archive]

  • MTF Weight Training: Get Strong, Not Big
  • transgenderfitlife.com/mtf-weight-training-get-strong-not-big/ [archive]

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