How Gender Dysphoria Puts Trans People at Greater Risk for Eating Disorders

cw: transphobia, transmisogyny, fatphobia, fatshaming, eating disorders, body dysmorphia

Gender dysphoria is often described as negative emotions stemming from the disparity between one’s gender identity and their physical appearance (body dysphoria), but it can also be about the disparity between their gender identity and other people’s perception of their gender (social dysphoria). When you feel like you don’t look enough like the gender you think you are, that’s body dysphoria. When other people call you “sir” when you want to hear “ma’am,” or when you don’t want to be gendered at all, that’s social dysphoria. Body dysphoria differs from body dysmorphia, which is a disorder wherein one is preoccupied with perceived physical flaws that others cannot see, but they are both body image issues, and there are many people who experience both.

I am a nonbinary trans person, and many of my friends are part of the transgender community. I’m a member of many social media trans communities. I’ve noticed it’s very common for people to say they don’t “pass” as cisgender (people who identify with the gender they were assigned at birth, usually due to their genitalia) because they are “too fat.” In part, for trans women, this is because our beauty standards for women include thinness. Conversely, beauty standards for men vary more, but most of them center around low body fat, and often high muscle density. Thinness is almost considered a prerequisite for androgyny.

At the same time, what we perceive as masculine fatness versus what we perceive as feminine fatness differs. People’s assigned gender at birth (AGAB) affects the shape of their body, especially if they have fat bodies.

Current evidence suggests that trans hormone replacement therapy (HRT) results in a redistribution of body fat to conform more to this standard, but there are many other potential outcomes of such a therapy, making it not desirable to everyone who is trans, and access to trans health services is not available to everyone who wants them.

On a personal level, I’m worried that this article might be used to further pathologize transness, that the right wing will point to it and say it supports the idea that being transgender is a disorder, and therefore not a valid identity. They did the same thing with homosexuality, and some still stand by that.

Gender dysphoria is classified as a psychological disorder in the DSM (the document that outlines the US diagnostic standards of psychology). Some doctors make it a requirement for trans patients seeking hormone therapy that the prospective patient get a formal diagnosis of gender dysphoria, when in fact, some trans people do not experience gender dysphoria at all, and that does not make them any less transgender or less deserving of gender-affirming health services. Insurance companies sometimes require at least a letter from a medical professional that confirms that the patient has gender dysphoria, or they will not cover these medical services.

Reactionaries point to this and they say that trans people are unwell, that we are disturbed, that therefore our assertions about our gender must be invalid, which is not just transphobic, but also ableist (discriminatory against people with disabilities, in this case people with mental illnesses). Mentally ill people can know things about their own identity, including what gender they really are.

In reality, the reasons why trans people are more likely to suffer from body image issues and disordered eating are mainly related to transphobia and trans people being pushed to conform to cisnormative (norms formed from a cisgender perspective) beauty standards. Instead of telling trans women they need to try harder to look like “real women” and vice versa with trans men, as a culture we need to start accepting that womanhood doesn’t mean having curves in “all the right places,” for example, and instead embrace womanhood in all its forms, the infinite variations of it. Womanhood and manhood shouldn’t be defined by the shape of one’s body, and honestly? Even cisgender bodies don’t always conform to those standards.

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