International Journal of Transgender Health (2025)
Authors: Emmett Line, Dougie Zubizarreta, Stephanie Budge, Ryan Watson, Allegra Gordon, S. Bryn Austin, and Sabra Katz-Wise.
Abstract:
Background
Transgender and/or nonbinary (TNB) youth experience elevated risk of body image concerns and disordered eating compared to their cisgender counterparts, yet drivers of this risk remain poorly understood. This exploratory community-engaged study examined longitudinal associations between gender minority stressors and protective factors and disordered eating and body image concerns among TNB youth.
Methods
30 TNB youth (age 13–17 years) from the U.S. New England region completed five waves of online surveys (December 2015–February 2019). Gender minority stressors included non-affirmation of gender identity and internalized cissexism. Protective factors included gender identity-related pride, community connectedness, and social support. Outcomes included disordered eating behaviors, body image concerns, body image-related avoidance, depersonalization, and trans-specific body image concerns.
Results
Gender-related pride was associated with fewer trans-specific body image concerns and vomiting for weight control in TNB youth. Over the study period, 20–40% reported dieting, 4–10% reported vomiting for weight control, and 8–23% reported binge eating. Greater gender minority stressors at the previous wave were associated with greater body image-related avoidance, depersonalization, and trans-specific body image concerns at the current wave.
Conclusions
Elevated risk of disordered eating and body image concerns in TNB youth highlight the need for screening, prevention, and systems-level efforts to address anti-TNB discrimination.