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In nutrition school, a lot of what I learned about how to determine nutrient needs for an individual was based on gender. Calculating calories, macronutrients, vitamins, and minerals are all based on being either male or female.
But, what if you don’t fit comfortably into either of those labels?
Approximately, 1 million Americans identify as transgender (1). It is believed that this number may not be totally accurate since gender identity is not usually recorded on population surveys and the population seems to be increasing.
To be honest, I didn’t learn anything in school about how to provide nutrition recommendations to a transgender individual. This is unfortunate because this population, just like people identifying as female or male, have different health and nutrition-related concerns and needs that should be appropriately addressed.
Due to the lack of knowledge and training on the part of healthcare professionals, like myself, the specialized needs of the transgender population frequently are overlooked or ignored. A survey by the Center for American Progress found that up to 19% of transgender individuals have been refused medical care due to their gender identity.
Transgender individuals are also less likely to report being in very good health, when compared to other groups (2). This survey raises concerns that the health needs of transgender individuals are not being met.
Although discrimination is definitely an issue, in order to provide quality, tailored nutrition recommendations to transgender people, more research and understanding is needed. The complexity of managing health and medical conditions in combination with hormone replacement therapy and other treatments all need to be considered before appropriate nutrition recommendations can be made.
Taking into account the true complex nature of the needs of this population, as a healthcare provider, I would strongly encourage you to first speak to your doctor before implementing any of the recommendations below.
Only someone who truly knows where you are in your journey, any other medical conditions you might have, and what medications or hormone treatments you are taking can make the right recommendations about the right supplements for you.
Take this list below as a starting point of possible supplements you might want to consider discussing with your provider, rather than blindly adding them to your routine.
What Is Transgender?
The word transgender is an umbrella term to refer to those who express their gender identity differently from their assigned biological sex. Gender is a cultural construct which is unrelated to someone’s sex at birth or physical attributes.
For those who do identify as transgender, the sex they were born with and gender identity do not match. Additionally, some people may identify as non-binary, meaning they don’t associate with either gender (3).
Those who identify as transgender may be in various phases of transition physical to the opposite gender or may choose to not transition at all. Understanding the phase of the journey is an important part of helping determine health and nutrition needs and concerns. This is why blanket recommendations for “all transgender people” cannot be made.
Special Nutrient Considerations
As I mentioned there is a lot of complexity when determining nutrition recommendations for transgender individuals. First, many calculations to determine basic information like calorie needs is based on whether one is male or female.
Hormone treatments and gender reassignment surgery can change these needs further depending where you are in the process.
Additionally, the transgender population has a higher prevalence of sexually transmitted diseases, body image issues, osteoporosis, cancer, and heart disease caused by hormone treatments.
Many are also at increased risk for drug and alcohol abuse, which further changes nutrition needs (4). All of these conditions should be considered before taking any dietary supplements.
Supplements for General Health
Based on the predisposition for certain medical conditions in this population there are a few supplements that could help maintain overall health.
Omega-3 Fatty Acids
Hormone replacement therapy increases the risk of heart disease and heart disease remains the number one cause of death for all people. Omega-3 fats have been found to lower many different risk factors of this disease.
These healthy fats do so by preventing abnormal heart beat, lowering heart rate, normalizing blood pressure, decreasing the risk of blood clots and lowering triglyceride levels in the blood (5).
Transgender individuals are also at increased risk for depression (6). Omega-3 fats have been shown to improve symptoms of depression. People with depression have lower quantities of omega-3s in their cells.
A 2003 study evaluated the use of omega-3s for the treatment of major depressive disorder. In this study, researchers gave 28 subjects either 9.6 g/day of omega-3 fats or a placebo in addition to their normal depression treatment. Those who received the omega-3s had significantly decreased depression scores after the 8 weeks when compared to a placebo (7).
The omega-3 fats, EPA, DHA, and ALA are essential fats in the human diet, meaning they must come from food. EPA and DHA are primarily found in fish, whereas ALA comes from plant sources such as walnuts and flax.
EPA and DHA are the active forms of omega-3s, whereas ALA needs to be activated into the other two. The conversion of ALA to EPA and DHA is notoriously ineffective, therefore it is best to get omega-3s from fish or supplements (8).
How to Take Omega-3 Fats
There are many different omega-3 fats available on the market which are sourced from different types of fish or plants. The recommended dose for heart health is 1 gram per day and 2 grams per day for depression.
Be sure to choose a supplement that contains both EPA and DHA. Ideally, it should be made from smaller fish, such as sardines, due to a lower risk of contamination by heavy metals.
Krill oil is also a good choice. If you prefer a vegan supplement, consider looking for one that is made with algae, the only vegan source of EPA and DHA.
Multivitamins are supplements that contain some or all of the basic nutrients that humans need to survive. The quantity of each nutrient that is needed is determined by the Dietary Reference Intakes which have been developed by the National Institute of Medicine and the National Academies.
Many of the Recommended Dietary Allowances (RDAs) for vitamins and minerals for both men and women are the same, with a few exceptions.
Women of reproductive age have higher iron needs then men due to monthly blood losses. Men need more zinc, magnesium, vitamin C, and some of the B-vitamins (9).
How to Take a Multivitamin
As a transgender individual which type of multivitamin should you choose? Even after transition, most of your vitamin and mineral needs will remain aligned with your biological sex.
Therefore, it would not be recommended for a trans female to take a women’s multivitamin with more iron because there is no need for increased iron. Instead look for a “general” multivitamin that is designed to meet the needs of any individual, rather than one of a specific gender.
And remember, a multivitamin is just an insurance policy and does not ever replace a healthy well-balanced diet.
If you are going through gender reassignment surgery, you may want to consider increasing your protein intake for a few weeks before surgery and until you are completely healed. The body needs protein for wound healing and tissue repair (10).
Additionally, if you are a transman your protein and calorie needs will increase if you are taking testosterone due to more muscle mass.
How to Take Protein Supplements
Protein can be found in food or in supplements. A few foods high in protein include meat, chicken, fish, dairy products, soy, and beans.
Protein powders are an easy and convenient way to get more protein into your diet. The type of protein powder you choose should be based on your individual goals, dietary preferences, allergies, and taste.
Whey protein is recommended for increasing muscle mass, but it may not be ideal for someone with lactose intolerance or a milk allergy.
Soy, brown rice, and pea proteins are all vegan options. When choosing a protein powder, select one with at least 20 grams of protein per serving and 10 grams of less of added sugar.
Related: The 9 best types of protein powders to consider
Supplements for Male to Female
Male to female (MtF) transgender are individuals who were assigned a male sex at birth and who wish to change or have already changed their body or gender identity into a more feminized role. MtF are usually referred to as transgender women.
Female hormone therapy can have many side effects including weight gain, increased fat mass, and changes in body composition. Estrogen therapy also increases the risk for developing blood clots and glucose intolerance which could lead to diabetes. MtF also have a higher prevalence of eating disorders and abusing diet pills (11).
One thing transwomen don’t have to worry about as much is bone density. Usually, as a woman enters menopause, estrogen naturally decreases, which in turn increases the risk for osteoporosis.
If a transwoman continues to take estrogen into older adulthood, bone density will not decrease as significantly.
Curcumin is the active ingredient in the spice turmeric, common in Indian cooking. It is an anti-inflammatory and has been found to reduce the risk of developing blood clots, which have been linked to estrogen therapy (12).
Curcumin is also protective of heart health, helping neutralize free radicals that lead to disease (13).
For a trans woman, a daily curcumin supplement may help decrease some of the cardiovascular risks associated with long-term hormonal therapy.
How to Take Curcumin
Although curcumin is found in turmeric, the spice itself is made up of only 3% curcumin. If you want an effective dose of curcumin you will need to take a supplement.
That’s not to say that you can’t enjoy turmeric in your food because it definitely adds a different type of flavor to food.
The World Health Organization recommends a daily intake of 1.4 mg of turmeric per pound of body weight (14). For a 150 pound person, this would translate to 210 mg of turmeric per day or 6.3 mg of curcumin.
Look for supplements that also contain peperine, a black pepper extract that helps increase absorption.
Related: A list of the best curcumin supplements
A side effect of estrogen therapy is that it can increase triglyceride levels. Triglycerides are fats found in your blood. If there is too much fat in your blood and the numbers get too high, this can increase your risk of heart disease.
There are many things you can do to lower triglycerides, such as limiting sugar and alcohol. The active ingredient in garlic, called allicin, has been found to also help decrease triglycerides and cholesterol levels (15).
Garlic can also lower blood pressure and other risk factors for heart disease, a concern for many transgender people.
How to Take Garlic Supplements
You can obviously add garlic to your food to get all the health benefits. It is full of flavor and incredibly healthy. But, if you have high triglyceride levels you may want to consider taking a garlic extract or supplement.
Look for one with an enteric coating so you don’t constantly smell like garlic. The recommended dose is between 600-1200 mg per day. Just be aware that more is not better as garlic can be toxic if consumed in extremely high doses.
Related: A list of the best garlic supplements
Supplements for Female to Male
A female to male (FtM) transgender is an individual whose assigned sex at birth is female but wishes to change their body and/or gender identity to male. FtM are usually referred to as transgender men.
When transitioning from female to male some may choose to undergo testosterone hormone therapy. This will cause an increase in bone and muscle mass, for a period of time.
LDL cholesterol levels, which increase the risk for heart disease, can also be elevated by testosterone.
Testosterone therapy may eliminate the menstrual cycle, meaning iron needs may decrease or change. Iron supplements should be avoided, unless recommended by a medical doctor.
Although at first testosterone therapy increases bone mass, taking testosterone for a long period of time can contribute to in increased risk of osteoporosis due to a decreased bone density (16).
Calcium supplements in combination with a high calcium diet may help mitigate some of these effects and keep bones strong.
How to Take Calcium Supplements
The RDA for calcium for most adults is 1000 mg per day (17). Calcium is found in many foods including dairy products, green leafy vegetables, and fish with bones.
Calcium supplements come in two forms, carbonate and citrate. Calcium carbonate is the preferred form because well-absorbed with food and is inexpensive. Calcium citrate can be taken on an empty stomach.
Supplements may contain various amounts of calcium, but the quantity in each should be listed on the Supplement Facts panel, making it easy to know how much you are getting. The more calcium you consume at once, the less efficiently it is absorbed. Ideally, you want to take two 500 mg doses a day (18).
Related: A list of the best calcium supplements
Vitamin D, sometimes called the sunshine vitamin, is needed for calcium absorption and therefore helps maintain bone strength. Vitamin D works by helping the body keep enough calcium in the bloodstream to promote bone mineralization.
Without enough vitamin D, the bones become thin and brittle.
Vitamin D also helps with cell growth, immune system function, and lowers inflammation. Additionally, low levels of vitamin D have been associated with an increased risk of cardiovascular disease, which is already a concern for the transgender population (19).
How to Take Vitamin D
The RDA for vitamin D is 600 IU, although many experts believe this might be too low. Deficiency of this vitamin is widespread, with 41% of the population being deficient. This number is even higher for those with darker skin or who live in colder climates.
If you are looking for a vitamin D supplement, be sure to choose vitamin D3, which is better absorbed than vitamin D2. Most over the counter supplements provide adequate amounts of vitamin D, but if you want to know exactly how much you need you can ask your doctor for a blood test.
Depending on your level of deficiency, your doctor may prescribe a supplement to get your numbers back to normal.
A Warning about Hormone Altering Supplements
In doing research for this article, I came across a lot of companies claiming to sell various hormone altering supplements marketed specifically to the transgender population.
Although these may be appealing, particularly with the cost of hormone therapy and reassignment surgeries being so high, they may also be extremely dangerous. There is also no evidence that they actually work.
They may alter or negate any treatment that you are already undergoing, therefore I would recommend avoiding these types of products all together.
The Bottom Line
Due to differences in body composition and nutrient needs, supplement recommendations may vary widely for a transgender person and can really only be assessed by a professional with access to a complete medical history.
Hormone therapy also changes what might be recommended in terms of supplements. In the end, it is best to work with a doctor or Registered Dietitian who is well-versed in transgender issues and concerns.
ⓘ Any specific supplement products & brands featured on this website are not necessarily endorsed by Ana.
Stock Photos from Andrii Zastrozhnov / Shutterstock
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