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Learn more about the results we get at Within

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Relearning intuitive eating on HRT

For many transgender and non-binary people, hormone replacement therapy (HRT) is gender-affirming and lifesaving. But taking new hormones comes with all types of changes that can take a while to adjust to, which can affect your appetite and metabolism. If you were practicing intuitive eating prior to HRT, you may find that you’ll have to learn your body’s new hunger and satiety cues.

Last updated on 
May 31, 2023
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In this article

The effects of hormone replacement therapy (HRT) on your appetite and cravings

Can HRT cause you to lose appetite and not eat?

Early research indicates that the hormone estrogen can decrease your appetite as well as reduce your food intake.1 But, it’s important to note that the research surrounding appetite and nutrition in transgender individuals on HRT is rather limited.

However, there are countless user-created Reddit discussions concerning appetite changes after starting HRT, and many trans women report experiencing increased appetite and food consumption after starting hormone therapy. Others report liking a wider variety of food. That said, many of the people in the forums reported that their appetite changes plateaued eventually, some as soon as a few months into HRT, while others took several years.

Can HRT cause an increase in appetite and eating? 

Yes, taking progesterone or testosterone will likely increase your appetite.1 Many trans men and trans masc people on Reddit note having increased appetites and feeling like they are always hungry. This may be because testosterone tends to increase a person’s basal metabolic rate, which is how many calories the body needs to support life-sustaining functions, such as breathing.3

Spironolactone, often called “spiro” amongst trans folks, is a testosterone blocker (gender-affirming hormone therapy) commonly taken by trans women and trans-feminine individuals. It’s also a diuretic that reduces blood pressure and causes the body to absorb less sodium.2 As such, people taking spiro may experience intense cravings for sodium—notably, trans feminine individuals report craving pickles.2

HRT affects everyone differently.

Trans-feminine people have also reported craving carbohydrates once they begin HRT, whereas trans-masculine individuals tend to crave more protein. Keep in mind, however, that this isn’t a hard and fast rule—this is based on individual self-reports from those in the community. 

And while some people undergo significant appetite and cravings changes, others have noted no discernible difference. Many trans and non-binary people also take lower or less consistent doses of hormones than may be typically prescribed, which can also affect variations in physical (e.g., changes in muscle mass) and appetite changes. Like anything else, HRT is going to affect everyone differently, but it’s important to be aware of the potential changes (including weight gain) so that you can tune into your body and eat accordingly.

What is intuitive eating, and how can you practice it while transitioning?

Intuitive eating is an eating practice centered around tuning into your body’s hunger and satiety cues and eating accordingly. It’s more or less the opposite of restrictive eating or diets followed to lose weight. Intuitive eating is based on the general principle of eating what you want and how much you want when you are hungry and stopping once you feel satiated. When you practice intuitive eating, you trust that your body knows what it needs to function optimally and provide you with energy. 

Many people have an intuitive approach to eating as young children, but diet culture as well as rituals and rules around eating, often disrupt our ability to listen to our body’s signals, known as body wisdom.

Various societal customs that compromise our body wisdom include:4
  • Being forced to eat specific types of food at specific times of day, regardless of personal preference
  •  
  • Being exposed to dietsBeing forced to finish everything on our plate as a child
  • Experiencing body-shaming and anti-fat bias (or misrepresentation of a healthy weight)
  • Being exposed to advertisements encouraging specific ways of relating to food
 

Does intuitive eating work for everyone? 

Intuitive eating is a great approach for many people, but may not be appropriate for others. Individuals in recovery from eating disorders or who have eating disorder histories may need to have more structure to eat consistently and adequately if they do not have reliable hunger cues. Other physical and mental health conditions can impact both dietary needs and the overall relationship with food in ways that make intuitive eating inaccessible. 

The main intention of intuitive eating is to re-learn body wisdom so you can eat when and what your body tells you to, without restrictions, but if you have a medical issue that necessitates a particular diet, make sure to stick to your doctor’s recommendations. 

How can you practice intuitive eating? 

Before medically transitioning, maybe you already were eating intuitively without giving it a name, and now you need to adjust to hormonal changes—or maybe you struggled with disordered eating due to body dissatisfaction. No matter what your eating habits or challenges are, it’s never too late to begin incorporating some of the principles of intuitive eating in a way that works for you. 

You can practice intuitive eating by:

  • Valuing your health, well-being, and energy over weight and appearance
  • Listening to your hunger cues to discern when and how much food to eat
  • Making sure to eat adequately and consistently, even in times of stress or intense emotions
  • Giving yourself permission to eat whenever you are hungry and to eat whatever you want
  • Avoiding obsession with body fat and weight gain, rather focusing on overall health

Relearning your body’s hunger and satiety cues may not come easily at first, and that’s normal—we have been taught so many harmful beliefs about food and our bodies over our lifetimes that we can’t expect to unlearn all of them in a day. As such, be kind to yourself and forgive yourself if you are struggling or find yourself thinking negative thoughts about food.

Trans person holding LGBTQ flag

The benefits of intuitive eating for trans people

Most of the research surrounding the benefits of intuitive eating has focused on cisgender women, with cis men, trans folks, and non-binary and gender-fluid people being left out. More research is needed to learn about the impacts of intuitive eating approaches to food in people of other genders.

Early research has shown the following benefits of intuitive eating:4,5,6

  • Improved body image
  • Improved self-esteem
  • Better mental health
  • Reduced weight cycling
  • Healthier psychological attitudes
  • Improved quality of life
  • Decreased depression and anxiety
  • Decreased likelihood of disordered eating
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Benefits of eating intuitively while receiving gender-affirming care

Many of the advantages of intuitive eating overlap with the benefits of gender-affirming care like HRT. Gender-affirming care is known to reduce psychological distress, depression, and suicidal ideation in trans folks.7,8

Additionally, gender-affirming care can improve body image and body satisfaction in those who had gender dysphoria before medically transitioning, as gender dysphoria can cause profound body dissatisfaction and psychological distress. As such, intuitive eating and gender-affirming care go hand-in-hand when it comes to loving and caring for your body.

Transgender and non-binary communities have high rates of eating disorders, and eating disorder behaviors may persist after an individual has started HRT.9 If you suspect you have an eating disorder or if food and weight concerns have become obsessive and destructive to your life, it is important to reach out for support. There are many professional and peer support resources that can help. While in recovery from an eating disorder, intuitive eating may not be accessible, and focusing on adjusting to consistent and adequate eating is a priority.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Hirschberg A. L. (2012). Sex hormones, appetite and eating behaviour in women. Maturitas, 71(3), 248–256.
  2. Pickles and transfems: Hormonal and cultural food craving in gender transition. (1967, January 1). Gastronomy Blog Pickles and Transfems Hormonal and Cultural Food Craving in Gender Transition Comments.
  3. Welle, S., Jozefowicz, R., Forbes, G., & Griggs, R. C. (1992). Effect of testosterone on metabolic rate and body composition in normal men and men with muscular dystrophy. The Journal of clinical endocrinology and metabolism, 74(2), 332–335.
  4. Van Dyke, N., & Drinkwater, E. (2014). Review Article Relationships between intuitive eating and health indicators: Literature review. Public Health Nutrition, 17(8), 1757-1766.
  5. Schaefer, J. T., & Magnuson, A. B. (2014). A review of interventions that promote eating by internal cues. Journal of the Academy of Nutrition and Dietetics, 114(5), 734–760.
  6. Bruce, L. J., & Ricciardelli, L. A. (2016). A systematic review of the psychosocial correlates of intuitive eating among adult women. Appetite, 96, 454–472.
  7. Mental health benefits associated with gender-affirming surgery. (2021, May 6). Harvard T.H. Chan School of Public Health. Retrieved March 30, 2023.
  8. Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. (2022). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Network Open, 5(2).
  9. Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 57(2), 144–149. 

FAQs

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