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 dysphoria
- 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
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.
King (2021)
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:
- Adult BMI calculator (age 20+) (Español)
- Youth BMI calculator (age 2-19) (Español)
BMI has four adult categories:
| Below 18.5 | Underweight |
| 18.5 – 24.9 | Healthy Weight |
| 25.0 – 29.9 | Overweight |
| 30.0 and Above | Obese |
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.
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
- 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
Diet
Gaining or losing weight is a very simple process.
- To lose weight, consume fewer calories than you burn.
- To gain weight, burn fewer calories than you consume.
Calories and weight are always the same:
- 1 pound = 3,500 calories
- 1 kilogram = 7,700 calories
If you want to lose 1 pound a week, you need to consume 3,500 fewer calories than you burn that week. That’s 500 calories a day. You can do this by consuming fewer calories, burning more calories, or a combination.
Your goal should be to change your habits so you can stay at your target weight. 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. If you are not hungry enough to eat an apple or a carrot, you are not really hungry. You are eating for other reasons.
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.
Consider a low-carb diet
- Carb is short for carbohydrate. Carbohydrates 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
- These foods make it harder to lose fat, because your body uses these for energy before it uses fat. If you do not eat carbs, your body burns fat instead.
- Cutting something out of 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
- SELFNutritionData (nutritiondata.self.com)
- 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.
To lower testosterone
- Reduce meat
- Reduce cholesterol
- Reduce fat
- Increase soy
To lower estrogen
- Increase fiber
- Increase flax seed
- Increase foods with sulfur
- Increase organic food
- 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.
Even if you do nothing all day, you will burn some calories. For instance, a sedentary woman my age and BMI burns about 2,000 calories a day just being alive. If she eats 2,000 calories a day, she will stay the same weight. If she eats 1,500 calories a day, she will lose one pound a week (500 fewer daily calories consumed x 7 days = 3,500 calories = 1 pound).
By adding daily exercise, you can lose even more weight. If the same woman does 15,000 steps every weekday as part of her job or other activity, she would burn an additional 700 calories a day (700 more calories burned x 5 days = 3,500 calories = 1 pound).
So with only diet or only exercise described above, she would lose a pound a week, but with both diet and exercise, she would lose 2 pounds a week.
Find out how much various activities burn from calculators like these:
SELFNutritionData (nutritiondata.self.com)
HealthStatus (healthstatus.com)
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
- Nonprofits:
- Overeaters Anonymous – OA (oa.org)
- Anorexics and Bulimics Anonymous – ABA (aba12steps.org)
- Eating Disorders Anonymous – EDA (eatingdisordersanonymous.org)
- Commercial groups:
- Weight Watchers (weightwatchers.com)
- Jenny Craig (jennycraig.com)
- Nutrisystem (nutrisystem.com)
- HMR (hmrprogram.com)
- Prepared meal delivery
- CookUnity (cookunity.com)
- BistroMD (bistromd.com)
- Factor (factor75.com)
- Freshly (freshly.com)
- Splendid Spoon (splendidspoon.com)
- Meal kit delivery
- Blue Apron (blueapron.com)
- Peach Dish (peachdish.com)
- Home Chef (homechef.com)
- Hungryroot (hungryroot.com)
- Sunbasket (sunbasket.com)
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 have been linked to facial aging and other unwanted side effects.
- Drugs approved by FDA include:
- bupropion-naltrexone (Contrave)
- lorcaserin (Belviq)
- orlistat (Xenical)
- phentermine-topiramate (Qsymia)
- GLP-1 agonists [glucagon-like peptide 1]
- semaglutide (Wegovy, Ozempic, Rybelsus)
- dulaglutide (Trulicity)
- exenatide (Bydureon, Byetta)
- liraglutide (Victoza, Saxenda)
- lixisenatide (Adlyxin) (daily)
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.
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)
- Adult BMI calculator (age 20+) (Español)
- Youth BMI calculator (age 2-19) (Español)
MDCalc (mdcalc.com)
- Check your own Charlson Comorbidity Index
Dietary Guidelines for Americans (dietaryguidelines.gov)
Choose My Plate (choosemyplate.gov)
- By the US Department of Agriculture
Bespoke Unit (bespokeunit.com)
- The ultimate guide to men’s body types.
Shop Your Shape (shopyourshape.com)
- Guide to women’s body types. Many trans women are inverted triangle.
Eating Disorder Hope (eatingdisorderhope.com)
- Founded in 2005; a great resource.
Diet.com (diet.com)
- Lots of useful meal plans at various calorie amounts.
For us, by us
River Eastwood (riverrunswild.com)
- Excellent articles and YouTube channel for transmasculine folks.
- https://www.youtube.com/channel/UC0EpePEAuG-UqRse3eW8TWQ
Laith Ashley (laithashley.com)
- Talked about his workout with Kyle Krieger.
- https://www.youtube.com/watch?v=NV96jnkd4ZA
Trans Out Loud (transoutloud.com)
- Nice suggested workouts for trans women.
Alayna June (alaynajune96)
- Booty workout for transwomen
- https://www.youtube.com/watch?v=6kTR8elZFOg
Trans & Fit (youtube.com/user/transandfit)
- Motivational YouTube channel by Alex, active 2015-2016.
Transgender Fitness Life (transgenderfitlife.com)
- MTF Weight Training: Get Strong, Not Big
Andrian Aliazas (youtube.com/user/TheAndrianAliazas)
- Motivational channel includes exercise tips for trans women.
- https://www.youtube.com/watch?v=S8MXKMsM9ig
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
References
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 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
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
Synott, Amy (January 24, 2023). Those weight loss drugs may do a number on your face: People using drugs like Ozempic are discovering an unwanted side effect: facial aging. New York Times https://www.nytimes.com/2023/01/24/style/ozempic-weight-loss-drugs-aging.html