Diet and exercise for transgender people

You can have better health before, during, or after a gender transition. It’s always the right time to do it. It doesn’t 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

Medical requirements

Everyone should know their body mass index (BMI). Adults are measured differently than children and teens. See the links below.

Some healthcare providers may require you to have a BMI within healthy weight in order to get hormones or surgery. BMI has four adult categories:

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

Some may also check your Charlson Comorbidity Index. This checklist assesses your age and current diagnosed medical issues, then estimates your likelihood of dying in the next ten years.

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 maintain your target weight. Here are some general suggestions that have clinical evidence 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 flavorings or carbonation.

Drink a caffeinated beverage

  • Stimulants suppress your appetite. Skip adding dairy and sugar to that coffee or tea, or at least cut back.

Don’t drink calories

  • Fruit juices and sugary soft drinks are full of calories that can be replaced with other options. Beer, wine, alcohol, and mixers have lots of calories, too, and they are often drunk while eating unhealthy foods.

Shop along the walls of the grocery store.

  • Produce, meats, dairy, and freshly baked goods made in-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 carbs and fat and salt.

Skip the fast food

  • It’s convenient, and it seems cheap, but it’s not a good choice. As an example, a Big Mac, large fries, and large Coke come to 1,340 calories. That’s about the same calories as a 10-inch Domino’s pizza or a Chipotle chicken burrito with cheese and guacamole. You’d 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, usually not very good for you, and the resort of people who don’t plan well. Pack a lunch, plan your dinners and breakfasts. You can make a lot of things in advance 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 don’t have a stove, you can make healthy hot meals at home with a microwave, hot plate, slow cooker, countertop grill/griddle, rice cooker, or toaster oven.

Trade out candy and salty snacks

  • Replace them with fruits, vegetables, and healthier options. If you’re not hungry enough to eat an apple or a carrot, you’re not really hungry. You’re 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

  • 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 are not very mindful about eating. If you keep track of everything you eat for a couple of weeks, you will start to see patterns where you can reduce calories. Use a calorie calculator for everything. When you see how much exercise you need to burn what you eat, you’ll start to rethink a lot of food choices. These sites all give nutrition information for common foods:

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’s usually pizza, or chocolate, or wine. Sometimes it’s going out with friends. The key is finding a good balance with treats so they really feel special.

Exercise

The US Centers for Disease Control and Prevention recommends 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:

Certain kinds of exercise can also change your body shape. Transmasculine folks often want to bulk but 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. Here are some ways to get help.

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 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.
  • Drugs approved by FDA include:
    • bupropion-naltrexone (Contrave)
    • liraglutide (Saxenda)
    • lorcaserin (Belviq)
    • orlistat (Xenical)
    • phentermine-topiramate (Qsymia)

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)

MDCalc (mdcalc.com)

Bespoke Unit (bespokeunit.com)

Shop Your Shape (shopyourshape.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.

For us, by us

River Eastwood (riverrunswild.com)

Laith Ashley (laithashley.com)

Trans Out Loud (transoutloud.com)

Trans & Fit (youtube.com/user/transandfit)

  • Motivational YouTube channel by Alex, active 2015-2016.

Transgender Fitness Life (transgenderfitlife.com)

Andrian Aliazas (youtube.com/user/TheAndrianAliazas)

Natalie (youtube.com/watch?v=S8MXKMsM9ig)

Wussy (wussymag.com)