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Eating Disorder Treatment in Trans and Gender Diverse People: What New Research Tells Us
Kai Schweizer
Why this research was needed
Trans and gender diverse people experience eating disorders at markedly higher rates than the general population, with some studies estimating up to 34% will meet criteria for an eating disorder diagnosis, and disordered eating behaviours occurring at up to 2.7 times the rate seen in cisgender peers.
Despite this, gender diversity has rarely been recorded in eating disorder research, and clinicians have had very little evidence to guide safe, effective treatment. This review is the first to systematically pull that evidence together.
The research team searched seven databases and screened over 1,600 studies, ultimately including 18 peer-reviewed papers: four quantitative studies and 14 case reports or case series describing the treatment of 207 trans and gender diverse people with eating disorders in total.
1,600+
Studies screened
18
Papers included
207
Trans and gender diverse people across included studies
Key findings
1. Eating disorder symptoms can improve, but symptom improvement does not always mean recovery
In all four quantitative studies, trans patients showed a reduction in eating disorder symptoms by the end of treatment. In three of the four studies, this reduction was comparable to cisgender patients receiving the same care, and in one study, average scores on a standard eating disorder measure nearly halved over the course of treatment.
However, trans patients consistently entered treatment with higher rates of depression, anxiety, and suicidal thoughts than cisgender patients, and these often remained elevated at discharge, even when eating disorder symptoms had improved. In one study, suicidal ideation in trans patients did not improve at all over the course of treatment.
The authors argue that treating eating disorder symptoms in isolation, without addressing gender-related distress, may not reflect genuine or lasting recovery.
2. Gender-affirming medical care may be a critical piece of the puzzle
Among the 24 cases reviewed, 70.83% showed improvement in eating disorder symptoms. Of those, 70.59% had accessed gender-affirming medical care such as hormone therapy, and 29.41% attributed their improvement specifically to that care rather than to eating disorder treatment itself.
Only one of the quantitative studies explicitly integrated gender-affirming medical care into treatment, and it was the only study to report comparable outcomes between trans and cisgender patients across every measure, including eating disorder symptoms, anxiety, depression, suicidal ideation, and satisfaction with care.
The review also highlights that eating disorder behaviours can, for some trans people, function as a way of managing gender dysphoria, for example by suppressing puberty or reducing the visibility of secondary sex characteristics. Removing that coping strategy through standard treatment, without addressing the gender dysphoria driving it, may leave underlying distress unresolved.
Why this matters
For clinicians
The findings support integrating gender-affirming medical care and gender-affirming adaptations, such as trans-affirmative cognitive behavioural therapy, into eating disorder treatment, rather than treating gender dysphoria as a distortion of body image.
For families and carers
Understanding that disordered eating in a trans person may be connected to gender dysphoria can help guide conversations with treating teams and support timely access to appropriate care.
For health services and policy makers
The review highlights a clear gap in formal guidelines for gender-affirming eating disorder treatment, and an urgent need for further research, including longer-term follow-up and more diverse samples.
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Reference: Schweizer, K., McGuffog, R., Zwickl, S., Jackson, B., Strauss, P., Miskovic-Wheatley, J., & Furzer, B. J. (2026). Eating disorder treatment outcomes in trans and gender diverse people: a systematic review. International Journal of Transgender Health, 1–23. https://doi.org/10.1080/26895269.2026.2694622
Access the full published report here
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