Paired with health care inequities frequently faced by the transgender community, it’s not surprising that transgender teens face a greater risk for eating disorders. In fact, one study of college students found that transgender individuals were four times more likely than their cisgender female peers to report an eating disorder diagnosis such as anorexia nervosa or bulimia, and two times more likely to report eating disorder symptoms like purging.1
“It’s become increasingly common to have transgender youth in treatment here, including those who open up about their gender identity for the first time,” says Janine Averbach, MSW, LCSW, Senior Primary Therapist at Princeton Center for Eating Disorders. “We have an incredible opportunity to allow them to explore their gender in a safe space, which for some has included name/pronoun preferences or haircuts and wardrobe changes. With respect to family involvement, parents also can openly process their feelings, which may include a sense of grief or loss.”
According to Medical Director Najeeb Riaz, MD, eating disorders can develop among transgender teens when they try to control the changes of puberty, a critical phase of development, which makes weight gain during treatment especially difficult.
"Malnourishment can suppress the development of secondary sex characteristics, so transgender males may use restricting or purging behaviors to suppress feminine changes and menstruation, while transgender females may do the same to reject their developing masculine features,” says Dr. Riaz. “But weight restoration in a medically secure manner is imperative to recover from an eating disorder and its comorbidities.”
It can be challenging to validate feelings about recovery while still embracing a recovery-oriented model of care. Yet once patients achieve a healthier physical state and gain positive coping mechanisms, they have a greater ability to pursue any longer-term goals related to gender. Establishing trust can enable this work to be accomplished.
“For any patient, it’s important to begin building rapport from day one,” adds Dr. Riaz. “With transgender teens, it’s even more critical, as they are often very wary about acceptance and sharing intimate details that they may have regretted discussing in the past. As caregivers, we are in a unique position to show compassion and understanding in helping those who may have been treated unfairly elsewhere regain their health and mental well-being.”
A Leader in LGBTQ Healthcare Equality
Penn Medicine Princeton Medical Center, home of Princeton Center for Eating Disorders, recently was awarded LGBTQ Healthcare Equality Leader designation by the Human Rights Campaign® (HRC) Foundation in the Healthcare Equality Index (HEI) 2019, which surveyed health care institutions across the country. The HRC Foundation is the educational arm of America’s largest civil rights organization working to achieve equality for lesbian, gay, bisexual, transgender, and queer people. Participating in the survey for the first time, Princeton Medical Center earned the top score of 100 to receive the designation of LGBTQ Healthcare Equality Leader.
Equitable Care for All
At Penn Medicine Princeton Health, all patients, without exception, have the right to high-quality, unbiased, patient-centered health care, regardless of sexual orientation or gender identity or expression.
1. Diemer EW, Grant JD, Munn-Chernoff MA, et al. Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. J Adolesc Health. 2015; 57:144–149.
Tips for Working with Transgender Teens
Maggie Moran, LCSW, Senior Therapist at Princeton Center for Eating Disorders, offers these tips for behavioral health providers working with transgender patients to provide care in an informed, compassionate, and effective manner:
- Don’t make the faulty assumption that transgender teens are going through a phase, or that it’s a whim. There is neurological and genetic evidence to support that transgender individuals legitimately experience themselves as the opposite gender.
- Always use the preferred pronoun, even if it does not match their current presentation.
- Don’t assume a sexual orientation based on gender identity—these are two separate concepts. A transgender individual can be anywhere on the spectrum between gay and straight, just like a non-transgender individual.
- While a transgender teen should not be defined by their transgender identity, it also shouldn’t be ignored. Consider asking the following questions:
- When did you begin to notice that your gender identity didn’t match your assigned sex?
- Did you communicate this to anyone?
- If so, how did they respond?
- Did you hide your gender identity from others?
- What feelings did this evoke?
- Above all, be compassionate. Chances are that these teens have been misunderstood and have experienced discrimination or even overt hostility on a daily basis. Address defensiveness or difficulty sharing with understanding and patience.